Treatments for Metastatic Renal Cell Carcinoma

Medically Reviewed by Sabrina Felson, MD on February 20, 2024
Written by Stephanie Watson
6 min read

Metastatic renal cell carcinoma is cancer in your kidneys that has spread to other parts of your body. It's also called stage IV renal cell cancer.

When cancer is at this stage, it's not curable. But you and your doctor still have many options.

Treatments for metastatic renal cell cancer include:

Talk about all your options with your doctor. Find out how each treatment can help you and what side effects it can have, so you can choose the best one for you.

Surgery is the main treatment for cancer that hasn't grown outside of the kidneys. Yet it can still be an option if your cancer has spread.

Radical nephrectomy is the main operation for this type of cancer. During this procedure, your surgeon removes the:

  • Kidney that has the tumor
  • Adrenal gland, which sits on top of that kidney
  • Lymph nodes nearby
  • Fat around the organ

If the cancer hasn't spread far, surgery may be a cure. It could help you live longer. The surgery can also relieve symptoms like pain and bleeding.

If you're not healthy enough for surgery, you have another option. A procedure called arterial embolization can relieve symptoms like pain and bleeding.

During this procedure, the surgeon places small pieces of a special gelatin sponge or other material into the main blood vessel that goes to your kidney. These pieces block blood flow to the organ. Without enough blood, the cancer will shrink.

Your doctor may want to do an arterial embolization before you have a radical nephrectomy. Shrinking the tumor can make it easier to do the surgery.

Any operation can have risks. If you’re having a kidney removed, it’s possible that you’ll have problems such as:

  • Infection
  • Bleeding
  • Pneumonia
  • A reaction to the anesthesia drugs
  • Damage to organs and blood vessels
  • Your other kidney fails

Before your procedure, ask your surgeon about the chances you could have these problems.

Your body can work like normal with just one kidney. It will take over the job of filtering your blood. Your doctor will do regular checkups to make sure that your other kidney works well.

If the cancer has gone to other parts of your body, you'll also need other treatments like targeted therapy and immunotherapy. These treatments kill any cancer cells throughout your body that are left behind after surgery.

Immunotherapy uses substances made in a lab or by your body to help your immune system fight kidney cancer. It's also called biologic therapy.

There are three general types. Checkpoint inhibitor medications have largely replaced treatments with interferon and IL-2 drugs.

Checkpoint inhibitors. Your immune system uses a system of "checkpoints" on the surface of your cells to tell which ones are normal and which are harmful. Cancer cells can sometimes use checkpoints to pass as healthy cells and hide from your immune system.

Checkpoint inhibitors are a newer drug type that turns off checkpoints to help the immune system find cancer cells.

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are two of the more common checkpoint inhibitors that can treat metastatic renal cell cancer.

Both of these medicines are given through your vein. It takes about 30 minutes for each dose. Nivolumab is given every 2 to 4 weeks. Pembrolizumab is given every 3 weeks.

Interleukin-2 (IL-2) is a man-made version of proteins that your immune system makes called cytokines, which help destroy tumor cells. The medicine activates your immune system to attack the cancer.

You can take IL-2 in one of two ways:

  • Through a thin tube that goes into a vein (IV). You get it in a hospital.
  • As a shot under your skin. You can get this in a doctor's office or give it to yourself at home.

In large doses, IL-2 can shrink tumors. But it only helps a small group of people with advanced renal cell cancer. And it can cause side effects like:

Interferon alpha slows a tumor's growth. You get it as a shot under your skin. It doesn't work very well by itself. Usually you'll take it with another drug, like bevacizumab (Avastin).

Side effects of this treatment include:

These medicines target parts of cancer cells that help them grow and survive. They're designed to kill cancer without harming healthy cells.

Targeted therapies for renal cell cancer include:

Anti-angiogenesis therapy. Tumors need a blood supply to grow. Angiogenesis is the process that tumors use to make new blood vessels. Anti-angiogenesis therapy cuts off blood vessel growth to "starve" tumors.

One of these drugs, bevacizumab (Avastin), blocks a protein called VEGF, which helps tumors grow new blood vessels. You often take it with the immunotherapy drug interferon alpha.

You get Avastin as an IV through a vein once every 2 weeks. Each IV takes between 30 and 90 minutes.

Side effects include:

Tyrosine kinase inhibitors (TKIs) target proteins called tyrosine kinases that help cancer cells and their blood vessels grow. These drugs include:

You take TKIs as a pill once or twice a day. Side effects from these drugs include:

mTOR inhibitors are medicines that target the mTOR protein, which helps cancer cells grow. They include:

Afinitor is a pill you take once a day. Torisel comes in an IV you get once a week.

Side effects from mTOR inhibitors include:

This treatment uses high-energy X-rays to kill cancer cells. Radiation doesn't work very well on kidney cancer. But it might be an option if you can't have surgery. It can also relieve symptoms like pain or swelling. Treatments that help you feel better without killing the cancer are called palliative therapies.

Usually, you'll get radiation from a machine outside your body. This is called external-beam radiation.

Side effects of radiation treatment include:

  • Fatigue
  • Skin redness
  • Upset stomach
  • Diarrhea

Chemotherapy uses medicine to kill cancer cells all over your body. It can treat cancers that have spread.

This treatment usually doesn't work very well for renal cell cancer. But it might be an option if you've already tried immunotherapy, targeted drugs, or both. Some chemotherapy drugs help a small number of people with advanced kidney cancer.

You take chemotherapy as a pill, or you get it through an IV into a vein. You usually get it in cycles -- a few weeks on, followed by a break.

Side effects of chemotherapy include:

Your doctor will help you decide on the best treatment or combination of treatments for your cancer. If you try a few and they don't work, ask your doctor about joining a clinical trial. These trials test new therapies for kidney cancer to see if they are safe and if they work. Your doctor can tell you if one of these trials might be a good fit for you.

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