Renal cell carcinoma treatment: What’s new and what's next

Renal cell carcinoma is the most common type of kidney cancer. Most treatments are focused on clear cell carcinoma, which is the most common subtype of this disease.

Often, patients who are diagnosed with renal cell carcinoma when it is in its earliest stages can be successfully treated. But what are the treatment options for early-stage disease as well as renal cell carcinoma that has spread to other parts of the body? How do you know which treatment is right for you?

Here’s what to know about current treatment options and new approaches being explored through clinical trials.

Active surveillance for renal cell carcinoma

If renal cell carcinoma is growing slowly, active surveillance may be an option, says Pavlos Msaouel, M.D., Ph.D. Patients under active surveillance will have checkups every few months and undergo imaging exams to see if the tumor is growing or spreading.

Some patients may be hesitant to choose this option, in fear of cancer spreading unchecked. But Msaouel says regular checkups generally make active surveillance a safe option.

Surgery, targeted therapy and immunotherapy could be options if the cancer advances, depending on your specific diagnosis.  

Surgery is an option when renal cell carcinoma hasn’t spread

Surgery to remove the affected kidney offers the highest chance for successful treatment when cancer hasn’t spread.

Your kidneys filter blood and waste in our bodies and help produce urine. Since we have two kidneys, it’s possible to live with one.

But if both kidneys are removed or if they’re not working, you will need dialysis indefinitely. Dialysis cleans the blood through a machine. 

Treatment options for metastatic renal cell carcinoma: targeted therapy and immunotherapy

It’s often more challenging to treat kidney cancer if it spreads to other parts of the body. This is known as metastatic disease. Kidney cancer is most likely to spread to the lungs, lymph nodes, liver or bones. Surgery may not be the best option for some patients with metastatic disease, especially if cancer has spread to more than one location.

When the cancer has spread, targeted therapy and immunotherapy may be effective. Targeted therapies work by stopping or slowing the spread of cancer on a cellular level. A type of immunotherapy called immune checkpoint inhibitors train your immune system to recognize and target cancer cells.

Most of the time, kidney cancer doesn’t respond to chemotherapy. “But the cellular characteristics that make kidney tumors resistant to chemotherapy also make them vulnerable to newer treatment options, including targeted therapy and immunotherapy,” Msaouel says.

Depending on your specific diagnosis and goals for treatment, your care team can customize a plan that can target the characteristics of the cancer for the best possible results.

Managing renal cell carcinoma treatment side effects

“Over the last decade, treatment advances have given patients with metastatic kidney cancer more time,” Msaouel says.

Though these treatment options can be effective at treating metastatic tumors, they also often come with challenging side effects, like diarrhea, fatigue and painful blisters on the skin.

Most of these side effects can be managed by adjusting your medication dose, or with other medications or treatment approaches.

For severe side effects, your care team may even suggest stopping your medication temporarily. “Even just one or two days after pausing treatment, patients feel the relief they need to recover before starting treatment again,” Msaouel says.

If you’re experiencing challenging side effects, talk to your care team. “We can help you come up with strategies to cope,” Msaouel says.  

Clinical trial explores whether radiation therapy could treat metastatic renal cell carcinoma

Msaouel has teamed up with radiation oncologist Chad Tang, M.D., to investigate whether radiation therapy can be used to manage metastatic kidney cancer as an alternative to systemic therapy.  

The side effects of radiation therapy tend to be more manageable than side effects from systemic therapies like chemotherapy, immunotherapy and targeted therapy, Msaouel says. He’s hoping that introducing this treatment approach can improve patients’ quality of life.

“We already know radiation therapy works well for treating lung cancer,” Tang says, “So, we wondered, why wouldn’t it work for kidney cancer that’s spread to the lungs?”

Early results from the clinical trial Msaouel and Tang are co-leading show that some patients with metastatic renal cell carcinoma can delay or avoid immunotherapy or targeted therapy – and their negative side effects – if they undergo radiation therapy first.

Depending on the size and location of the tumors, intensity modulated radiation therapy or stereotactic body radiation therapy may be used.

“It’s not just about improving quality of life,” Msaouel says. “We’re also improving survival for our patients.”

By radiating metastatic cancer cells, they can shrink tumors – and potentially even keep them from coming back for years at a time with fewer treatments and fewer side effects.

“Our goal is to turn a terminal diagnosis into a chronic disease,” Tang says.

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