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Understanding treatment for kidney cancer and how it is delivered

Last modified: February 10, 2022

What are the treatment options for kidney cancer? Treatment options

The primary treatment options for kidney cancer include surgery, radiofrequency ablation, radiation therapy, chemotherapy, targeted therapies and immunotherapy. Tumours that are small and confined to the kidney may only require active surveillance to monitor the cancer through regular tests and scans. The type of treatment you receive will depend on a number of different considerations, such as the type of kidney cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how kidney cancer treatment works in the private health system.

Types of kidney cancer treatmentTypes of treatment

Surgery

Radiofrequency ablation

Radiation therapy

Chemotherapy

Targeted therapies

Immunotherapy

Clinical trials

Surgery for kidney cancerSurgery

Surgery is often the first step in treating kidney cancer. In most cases, part or all of the kidney is removed. If the cancer has spread beyond the kidney, other cancerous tissue, including surrounding lymph nodes, may also be removed. Surgical options for the treatment of kidney cancer include:

Radical nephrectomy

A radical nephrectomy involves surgically removing the entire kidney, as well as a section of the surrounding healthy tissue. In some cases, nearby lymph nodes and adrenal glands may also be removed. A nephrectomy may be performed through a single incision to the abdomen or through laparoscopic surgery, where several small incisions are made to access the kidney through the abdomen.

Partial nephrectomy

A partial nephrectomy, also referred to as kidney-sparing or nephron-sparing surgery, is a procedure which removes the cancerous tumour from within the kidney along with a small amount of surrounding healthy tissue. Unlike a radical nephrectomy, only part of the kidney will be removed. This type of surgery is the preferred course of treatment, as it may save kidney function.

Radiofrequency ablation for kidney cancerRadiofrequency ablation

Radiofrequency ablation is a less common treatment option for kidney cancer and is typically used for patients who are considered unfit to undergo surgery. This method destroys cancer cells through inserting a needle directly into the tumour, which then directs electrical currents into the cancerous tissue.

Radiation therapy for kidney cancer Radiation therapy

Types of radiation therapy commonly used for people with kidney cancer include:

Most patients who receive radiation therapy for kidney cancer will receive external beam radiation therapy. The most common type of EBRT treatment for kidney cancer is stereotactic radiation therapy (SBRT/SABR), which is used to treat small tumours in the kidney with well-defined edges when surgery is not recommended.

Chemotherapy for kidney cancerChemotherapy

Chemotherapy uses a range of drugs to kill and slow the growth of kidney cancer cells. Typically, chemotherapy is only used to treat advanced kidney cancer that does not respond to other treatments, including targeted therapies and immunotherapy. In certain circumstances, chemotherapy drugs may be used in combination with targeted therapy and immunotherapy to help shrink kidney cancer cells.

Learn more about chemotherapy and how it is delivered.

Common chemotherapy medicines

There are a number of different chemotherapy drugs that are used to treat kidney cancer. These drugs are typically combined based on the type of kidney cancer you have, your cancer’s stage and how much it has spread. Some of the drugs used include:

5-fluorouracil (5-FU)

This works by stopping the production of thiamine within cancer cells so they are not able to make the essentials proteins (RNA and DNA) that they need to divide and grow. It is given by intravenous infusion, usually in combination with a targeted therapy drug.

Targeted therapy for kidney cancerTargeted therapy

Targeted therapies use specialised drugs to destroy specific proteins in kidney cancer cells. They are commonly used to treat advanced kidney cancer and kidney cancer that is growing quickly.

Tyrosine kinase inhibitors (TKIs)

These drugs work by blocking a protein called VEGF (vascular endothelial growth factor growth) on the surface of kidney cancer cells. By blocking the VEGF protein, kidney cancer cells no longer get the nutrients they need to grow and spread. These medications are usually taken orally as a tablet or capsule once or twice daily.

TKI drugs include:

Axitinib
Cabozantinib
Sorafenib
Sunitinib
Pazopanib

mTOR inhibitors

These work by blocking a protein called mTOR which stimulates kidney cancer cells to grow. Blocking this protein helps to slow down the growth of kidney cancer cells.

Common mTOR inhibitor medicines

mTOR inhibitor drugs for kidney cancer include:

Temsirolimus

This is given by intravenous infusion every week, with each infusion usually taking around one hour. It is used to treat advanced (metastatic) kidney cancer.

Everolimus

This is given orally as a capsule once daily. It is usually given as a second line treatment, following treatment with a tyrosine kinase inhibitor drug.

Immunotherapy for kidney cancerImmunotherapy

Immunotherapy treatment uses your own immune system to destroy and slow the growth of kidney cancer cells. Like other drug-based therapies, immunotherapy is usually only recommended for the treatment of advanced kidney cancers and to help prevent kidney cancer from returning.

Immunotherapy drugs can be combined with targeted therapy drugs to treat advanced (or metastatic) kidney cancer.

Monoclonal antibody drugs

Most immunotherapy drugs that are used to treat kidney cancer are knowns as monoclonal antibody drugs, which belong to a class of drugs called checkpoint inhibitors. They work by binding onto certain ‘checkpoints’ (PD-1, PD-L1 and CTL-4) on the surface of T cells, which allows them to detect and destroy cancer cells or slow their growth.

Common monoclonal antibody medicines

Some common monoclonal antibody drugs which are used to treat kidney cancer include:

Nivolumab

This is given by intravenous infusion every three weeks, with each infusion taking around one hour. It may be given alone or in combination with ipilimumab.

Ipilimumab

This is given by intravenous infusion every two weeks to three weeks and is usually given together with nivolumab.

Avelumab

This is typically given by intravenous infusion every two weeks. It may be given in combination with a targeted therapy drug called axitinib.

Clinical trials for kidney cancer

Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients.

See current kidney cancer clinical trials delivered by Icon Cancer Centre.

Treatment by stage of kidney cancerTreatment by stage

When you are diagnosed with kidney cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.

Common treatment options for each stage of kidney cancer include:

Stage I and II kidney cancer

For early-stage kidney cancers, active surveillance may be an option if tumours are small and confined to the kidney. If further treatment is required, a partial or radical nephrectomy is usually performed while the cancer is still contained to the kidney. A lymphadenectomy may also be performed to remove surrounding lymph nodes.
Stage III kidney cancer

Stage III kidney cancers are treated similarly to stage I and II kidney cancer. Treatment will usually begin with a radical nephrectomy and lymphadenectomy. Following surgery, you may receive targeted therapies and immunotherapy to lower the risk of your cancer returning.
Stage IV kidney cancer

Treatment for stage IV kidney cancer typically begins with surgery. However, advanced kidney cancer is considered very difficult to cure and, in many cases, treatment will focus on palliative care to manage your pain. After surgery, you may receive immunotherapy, targeted therapy or chemotherapy to treat your cancer and manage your symptoms. Radiation therapy may also be used to treat areas in which the cancer has spread.

ReferencesReferences

For a full list of references, click here.

The American Society of Clinical Oncology. (2021, November 19). Kidney cancer – types of treatment. Cancer.Net. Retrieved December 20, 2021, from www.cancer.net/cancer-types/kidney-cancer/types-treatment
Mayo Foundation for Medical Education and Research. (2020, June 25). Kidney cancer: diagnosis & treatment. Mayo Clinic. Retrieved December 20, 2021, from www.mayoclinic.org/diseases-conditions/kidney-cancer/diagnosis-treatment/drc-20352669
Cancer Council Victoria. Kidney cancer: Treatment for early kidney cancer. Cancer Council Victoria. (n.d.). Retrieved December 20, 2021, from www.cancervic.org.au/cancer-information/types-of-cancer/kidney_cancer/treatment_for_kidney_cancer.html
American Cancer Society. (2021, November 2). Chemotherapy for kidney cancer. American Cancer Society. Retrieved December 20, 2021, from www.cancer.org/cancer/kidney-cancer/treating/chemotherapy.html
Cancer Council. (2020, November). Kidney cancer: Causes, symptoms & treatments. Cancer Council. Retrieved December 20, 2021, from http://www.cancer.org.au/cancer-information/types-of-cancer/kidney-cancer www.cancer.org/cancer/kidney-cancer/treating/by-stage.html
B. Escudier, C. Porta, M. Schmidinge, S. Gillessen, A. Horwich. Annals of Oncology Special articles| Volume 30, ISSUE 5, P706-720, May 01, 2019. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. DOI:https://doi.org/10.1093/annonc/mdz056

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