Kidney Cancer

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Nonsurgical Treatment

Chemotherapy uses chemical agents to destroy cancer cells throughout the body. Unfortunately, RCC has proven to be particularly resistant to chemotherapy. Research to develop more effective chemotherapy drugs to treat RCC is ongoing, however, and a number of them are currently being tested.

Drugs approved by the FDA to treat advanced RCC include sorafenib (Nexavar®), sunitinib (Sutent®), and temsirolimus (Torisel™). These drugs may slow progressive of the disease and increase survival time in some patients. They should be used with caution in patients who have high blood pressure (hypertension), heart or liver problems, bleeding disorders, or other kidney problems.

Side effects include rash, fatigue, mouth sores, diarrhea, and nausea. These medications can cause birth defects and women should not become pregnant within two weeks of taking them.

Radiation therapy involves using high-energy x-rays to shrink tumors and destroy cancer cells. This treatment may be delivered as a focused beam that is projected into the body (called external therapy) or in the form of radioactive materials placed at the site of the cancer through thin plastic tubes (called brachytherapy).

Radiation therapy is used often as follow-up (adjuvant) treatment to destroy cancer cells that remain in the body after a radical or partial nephrectomy.

It also may be used as palliative therapy to lessen pain or bleeding in patients with inoperable or widespread metastatic RCC. In such cases, there is no expectation of cure; the object is simply to ease the patient's discomfort.

Radiation therapy alone has a relatively low success rate in treating RCC, and often produces unpleasant side effects:

• Diarrhea
  
• Fatigue
  
• Headaches and cognitive problems (if treating metastatic cancer of the brain)
  
• Lung and respiratory problems (if treating cancer that has spread to the lungs or bones in the chest)
  
• Nausea
  
• Skin irritations
  

Agents such as estrogen, progesterone, and tamoxifen have been used with varying degrees of success to stop some types of cancer from growing. There is little evidence, however, that hormone therapy, either primary or adjuvant, is effective when used to treat RCC. Some recent studies show success rates of 5% to 10%. At best, it remains a subject for future research.

Biological Therapy

Over the last 10 years, there has been much interest in the use of biological agents, primarily interleukin and interferon, to boost, restore, or direct the patient's immune system to fight RCC in the same way it would fight an infection. There are data to suggest that these agents effectively treat this disease and can at times produce complete remissions. Both interleukin and interferon are approved by the FDA for treating metastatic RCC.

Some recent studies suggest that combining biological therapy with chemotherapy (chemobiological) therapy produces significantly higher response rates than biological therapy alone, although the data need to be confirmed in a larger study.

The side effects of chemobiological therapy include, but are not limited to the following:

• Depression
  
• Fatigue
  
• Fever
  
• Fluid retention and associated weight gain
  
• Loss of appetite
  
• Nausea
  
• Renal and liver failure
  
• Risk of infection and bleeding
  
• Skin rash
  

Kidney Cancer, Types of Treatment reprinted with permission from urologychannel.com
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