What to ask about subcutaneous immunotherapy for RCC

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, accounting for approximately 90 percent of cases. RCC begins in the cells that line the tubules, small tubes that filter blood as it moves through the kidneys. Like other types of cancer, RCC begins when normal cells undergo changes or mutations, forming abnormal cells that grow in an uncontrolled way.

Immunotherapy is a category of cancer treatment that helps the body's immune system identify and destroy cancer cells. It has become a significant part of treatment for many types of cancer, including RCC, particularly in the advanced stages of RCC that cannot be fully removed with surgery or RCC that has spread beyond the kidney.

Subcutaneous immunotherapy refers to immunotherapy drugs that are administered with an injection into the subcutaneous layer, a layer of tissue just below the skin. The subcutaneous layer is a helpful route of administration for drugs, allowing for absorption into the lymphatic system (a network of vessels, lymph nodes, and organs that transports immune cells and removes unwanted substances from the body).

Subcutaneous immunotherapy is a new and emerging treatment option for RCC. Most immunotherapy drugs are administered intravenously, with an infusion into a vein. Subcutaneous immunotherapy may offer a few advantages, including shorter appointment times and greater flexibility about where injections can be administered. This may help make immunotherapy drugs more accessible to more people treating RCC and other cancers.

If you or a loved one is living with RCC and immunotherapy is a treatment option, it may be worth discussing subcutaneous immunotherapy with your healthcare team. With that in mind, here are some questions to help you get started.

What subcutaneous immunotherapy drugs are available?

As mentioned above, subcutaneous immunotherapy is a somewhat new and emerging treatment option. The number of immunotherapy drugs that are available as a subcutaneous injection is limited (but expected to expand in the future). Your first question will be whether the subcutaneous immunotherapy drugs that are available are a good fit for your diagnosis.

What will an injection appointment be like?

If subcutaneous immunotherapy is a treatment option, talk to your healthcare providers about the details of the injection appointments, including what the injection process is like, how long you can expect to be at an injection appointment, and how much of that time will be spent on the injection. Subcutaneous injections typically take 3 to 7 minutes to administer, though the overall appointment will take longer.

What part of the body will the injections be administered?

Subcutaneous injections are typically administered to the abdomen or thigh, though specific drugs can only be injected at specific sites.

Where can you go for an injection appointment?

While intravenous infusions typically require a visit to an infusion center or a hospital, subcutaneous immunotherapy can be administered at a healthcare provider's office. Along with shorter appointment times, this may help make immunotherapy more accessible.

What side effects can this therapy cause?

Like all cancer treatments, immunotherapies can cause side effects. Side effects can vary depending on the drug, and side effects can vary depending on how that drug is administered. Fatigue, itching, cough, joint pain and muscle pain, and GI distress are common immunotherapy side effects. Your healthcare providers can recommend medications and strategies to ease side effects.

How can you expect to feel during and after an injection?

Ask your healthcare provider about how you can expect to feel immediately after an injection and in the days after. Ask if they have recommendations, such as having someone there to drive you home after the injection or taking a day off of work.

How can you expect to feel for the duration of treatment?

The duration of treatment can also vary from person to person, depending on the cancer and the therapy being used. Ask what you can expect to feel like during treatment. Ask what lifestyle adjustments you need to make. For example, steps to prevent infections.

How often will treatments need to be administered?

The frequency of injections can vary from person to person. Ask your healthcare provider how often you will come in for injections. Also ask how often you will need to come in for checkups and exams, which will be needed to monitor your response to treatment and side effects.

Preparing for your appointments

The questions above are intended as a starting point. Take time to think about what you want to know and write down a list of questions for your next appointment. It can also help to bring a loved one to your appointment, both as emotional support and to help you take notes.

Remember, your healthcare team will be your best source of information, and you are also an important source of information to your healthcare team. Knowing your concerns and questions can help your healthcare team provide you with better care.