How Immunotherapy Treats Advanced Renal Cell Carcinoma
We don’t seem to hear a lot about kidney cancer (renal cell carcinoma), but it’s among the 10 most common cancers in the United States. Over 60,000 people every year in the U.S. are diagnosed with it. Unfortunately, because most symptoms don’t become obvious until the tumors are larger, many people are diagnosed with kidney cancer only after it has progressed to later stages, when it is called advanced renal cell carcinoma.
For many years, treatment options for advanced renal cell carcinoma were limited. Traditional chemotherapy isn’t as effective on advanced renal cell carcinoma as it is on other types of cancer and when it is effective, the cancer often returns within a few years and is more difficult to treat.
Using Immunotherapy to Fight Advanced Renal Cell Carcinoma
Immunotherapy, also called biologic therapy or biotherapy, is a treatment that uses your immune system to fight a disease it normally might not recognize, such as cancer. The therapy can do this by stimulating your immune system to attack cancer cells or tumors, or by giving you specific immune system proteins that will act on the cells. One of the biggest advantages of immunotherapy over chemotherapy is immunotherapy attacks only the cancer cells without affecting the healthy cells in the body, reducing the number and severity of possible side effects.
Types of Immunotherapy
Research into different types of immunotherapy is ongoing. Currently there are four main types that can be used to treat advanced renal cell carcinoma and even more are being studied.
Immune checkpoint inhibitors: Tumor genes can express proteins that fool the immune system to think no threat is present. Immune checkpoint inhibitors help your immune system by blocking these proteins. The reawakened immune system can recognize the cancer cells and directly attack them. Because your immune system is looking for these specific tumor proteins, it doesn’t attack healthy cells. There are different classes of checkpoint inhibitors, depending on what part of the cell they target. Checkpoint inhibitors currently used for treatment of advanced renal cell carcinoma include nivolumab (Opdivo) and iIpilimumab (Yervoy).
Angiogenesis inhibitors: Some cancer tumors grow by developing new blood vessels, which allow the tumors to gather the nutrients they need. Immunotherapy agents called angiogenesis inhibitors stop the tumors’ ability to do this. Bevacizumab (Avastin) is one of the angiogenesis inhibitors used to treat advanced renal cell carcinoma.
Targeted therapies: Targeted therapies allow drugs to directly block enzymes tumors use to grow and multiply. These targeted therapies include sunitinib (Sutent), pazopanib (Votrient) and everolimus (Afinitor), among others. While these are not technically immunotherapies, they are often put together in this group because of the way they target the cancer cells.
Therapeutic vaccines. Most of us are familiar with the traditional vaccines we use to prevent illnesses, such as polio and tetanus. Therapeutic vaccines work differently and are given to patients who have a disease rather than to prevent it. When a therapeutic vaccine is given to someone with a disease like advanced renal cell carcinoma, it triggers the immune system to fight against it. These vaccines are still in clinical trials, but results are promising.
Immunotherapy Side Effects
As with all medications, immunotherapy can cause side effects in some people. However because immunotherapy targets the cancer cells alone, the risk of side effects is lower than with chemotherapy. And if side effects do occur, they are generally less severe. Side effects can include:
Increased risk of infections
Although it isn’t common, more severe reactions can affect different organs, causing failure of the liver, lungs, and heart, among others.
Understanding Your Therapy
Before starting any type of treatment, it’s important that you understand what’s going to happen. Speaking with your doctor or cancer care team will help you prepare for your treatment. Some questions you may want to ask could include:
How many sessions will I have and how much time is in between each session?
Is my medication given by pill or intravenous (IV)?
What are the known side effects of this treatment?
Will there be any interactions between this treatment and the medications I currently take?
Are there any medications or supplements I shouldn’t take?
Are there any activities I should avoid while receiving treatment?
Am I at increased risk of infection during treatment and if so, how long does this risk last after I’m finished?
How will I know if the treatment is working?
There are many more treatment options available now than ever before for people with advanced renal cell carcinoma and doctors are optimistic that these will not only extend their patients’ lives, but extend them while they enjoy a good quality of life.