Advanced renal cell carcinoma (RCC) is a type of cancer that began in the kidney but has grown beyond the kidney. Advanced RCC cannot be completely removed with surgery or destroyed with another type of localized therapy, such as radiation therapy. It includes some stage III cancers, stage IV cancers, and metastatic cancers.
Advanced RCC is not curable, but treatment can help a person with this type of cancer live longer and have a better quality of life.
Over the past decade, anti-cancer drugs called targeted therapies have become a mainstay of treatment for advanced RCC.
How targeted therapies work against cancer
Targeted therapies get their name because they act on specific molecules, or “molecular targets” found on cancer cells. Different targeted therapies work in different ways. A few examples that are used in the treatment of advanced RCC:
- Tyrosine kinase inhibitors (TKIs): These drugs block enzymes called tyrosine kinases, which are often overactive in cancer cells. Blocking these enzymes can prevent cancer cells from growing.
- mTOR inhibitors: These drugs block mTOR proteins, which helps prevent cancer cells from growing and helps prevent the formation of blood vessels that tumors need to grow.
- Hypoxia-inducible factor (HIF) inhibitors, which block another protein (hypoxia-inducible factor 2 alpha) that cancer cells use to grow and form blood vessels to supply tumors.
Basically, this group of targeted therapies starves cancer cells of proteins that those cancer cells need to survive.
Some targeted therapies are used in combination with immunotherapy
Combination therapy refers to using two types of cancer treatment at the same time. This has become a standard of treatment for advanced RCC over the past decade.
Combination therapies for advanced RCC typically involve two immunotherapies, or an immunotherapy used with a targeted therapy.
Immunotherapies work by helping the body’s immune system identify and destroy cancer cells. The majority of immunotherapies used in the treatment of RCC are immune checkpoint inhibitors. These drugs work by disabling immune checkpoints, proteins that help cancer cells evade detection by the immune system.
Targeted therapies can be used as second-line treatment
Targeted therapy drugs are also used on their own, without immunotherapy. This is called monotherapy. Monotherapy with certain targeted therapy drugs may be used as the initial treatment for advanced RCC.
Monotherapy with a targeted therapy drug is also a common approach to second-line therapy (and third-line therapy) for advanced RCC.
In cancer treatment, “first-line therapy” refers to the initial cancer treatment, while “second-line therapy” refers to a treatment that is used when the cancer does not respond or stops responding to the initial treatment. There are also third-line therapies.
Monotherapy with a targeted therapy is a common approach to second- and third-line therapies in advanced RCC. And studies have found that there is a significant need for second- and third-line therapies among people living with advanced RCC.
It’s important to remember that there is no best treatment for advanced RCC, only the treatment that is right for a specific person at a specific time. Treatment for advanced RCC is highly individualized, and many different factors are considered when making treatment recommendations. Your best source of information about your diagnosis and treatment options will be your healthcare team.
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