Kidney Cancer: Immunotherapy
What is immunotherapy?
Immunotherapy is a treatment that use medicines to kill cancer cells or slow their
growth. It’s not the same as chemotherapy (chemo). Chemo does not work well for kidney
cancer. Immunotherapy medicines work in different ways and cause different side effects.
Immunotherapy is also called biologic therapy. This cancer treatment works with your
body’s own immune system to find and kill cancer cells. These medicines boost, focus,
or restore certain parts of the immune system.
When might immunotherapy be used for kidney cancer?
Your healthcare provider may advise this treatment if the cancer has spread beyond
your kidney or comes back after treatment.
How is immunotherapy given for kidney cancer?
There are different kinds of immunotherapy medicines used for kidney cancer. They
may be given as shots (injections) or as an infusion. This means they are put into
your bloodstream through an IV (intravenous) line.
The 2 main types of immunotherapy medicines used for kidney cancer are: immune checkpoint
inhibitors and cytokines.
About immune checkpoint inhibitors
These medicines help your immune system find and kill cancer cells. Sometimes kidney
cancer cells use certain proteins to keep your immune system from attacking them.
These proteins are called checkpoints. Medicines that block these checkpoints can
boost your immune system against these cancer cells. This can shrink some tumors or
slow their growth.
Immune checkpoint inhibitors used for kidney cancer include:
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Avelumab
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Ipilimumab
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Nivolumab
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Pembrolizumab
All of these are given as IV infusions every 2, 3, or 4 weeks.
About cytokines
Cytokines are proteins the body makes to help boost the immune system. Versions of
these proteins that are made in a lab can be used to treat kidney cancer. They act
like the natural proteins to turn on the immune system. They might be used if other
immunotherapy medicines don't work.
Cytokines include:
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Interleukin-2 (IL-2). This medicine given as an IV infusion. Low doses may be given
as outpatient therapy, but high doses work better. High-dose IL-2 can cause serious
side effects. It's only given at cancer centers that have a lot of experience with
this treatment.
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Interferon alfa. This medicine doesn't work as well as IL-2. It's most often given
along with another medicine called bevacizumab. It's common to take interferon alfa
for many years. This can be done as long as it's working and the side effects aren't
too severe. It's given as an injection a few times a week. You can get it as an outpatient
at a hospital, clinic, or healthcare provider’s office. This means you go home the
same day. Or you may learn how to give it to yourself at home.
What are possible side effect of immunotherapy?
Most types of cancer treatment can cause side effects. Some can be severe. Side effects
depend on the type and dose of medicines you take.
Side effects vary for each person. It's important to tell your treatment team about
any side effects you have. Many of them can be treated to keep them from getting worse.
They tend to get better over time after treatment ends.
Possible side effects of immunotherapy include:
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Appetite loss
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Constipation
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Cough
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Diarrhea
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Itchy skin
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Joint pain
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Nausea and vomiting
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Shortness of breath
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Skin rash
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Tiredness (fatigue)
Serious side effects can include:
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Changes in mental function
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Fast heartbeat
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High fever and chills
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Low or high blood pressure
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Pain in the belly (abdomen)
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Severe diarrhea
These severe side effects are less common:
In rare cases, some of these side effects can cause death. Because of the risk of
severe side effects, these treatments are not an option for everyone. They're used
to treat kidney cancer only in people who are otherwise in good overall health and
can cope with side effects.
Working with your healthcare provider
It's important to know which medicines you're taking. Write down the names of your
medicines. Ask your healthcare team how they work and what side effects they might
cause.
Ask your healthcare providers what symptoms to watch for. Ask when to call them. For
example, many of these medicines can cause diarrhea. You may be told to drink a lot
of fluids, not eat high-fiber foods, and call if you have 4 or more loose bowel movements
a day for more than 2 days.
Make sure you know what number to call with questions or problems. Ask if there is
a different number to call after hours when the clinic is closed.
It may help to keep a diary of your side effects. Write down physical, thinking, and
emotional changes. A written list will make it easier for you to remember your questions
when you go to your appointments. It will make it easier for you to work with your
healthcare team to make a plan to manage your side effects.