Understanding Kidney Cancer Drugs renal cell carcinoma (RCC), is a type of cancer that starts in the kidney

Understanding Kidney Cancer Drugs renal cell carcinoma (RCC), is a type of cancer that starts in the kidney

It is one of the most common types of cancers with rates on the rise worldwide. While surgery is usually the first line of treatment, drugs also play an important role in managing kidney cancer. In this article, we take a look at some of the major drugs used for treating kidney cancer at various stages.

Targeted Therapy Drugs

Targeted therapy drugs work by targeting specific abnormalities within cancer cells. Kidney cancer cells often have mutations in genes that help control cell growth. Targeted drugs block the effect of these gene mutations to slow cancer growth. Some of the main targeted drugs used for kidney cancer are:

- Tyrosine Kinase Inhibitors: Kidney Cancer Drugs  Drugs like Sunitinib (Sutent), Pazopanib (Votrient), Axitinib (Inlyta), Cabozantinib (Cabometyx), Lenvatinib (Lenvima) work by blocking tyrosine kinases - proteins that help signals pass between cells. This disrupts signals telling cancer cells to grow and multiply. These drugs are commonly used as first-line treatment after surgery.

- mTOR Inhibitors: Everolimus (Afinitor) and Temsirolimus (Torisel) block activity of the protein mTOR that helps cancer cells grow and divide. They are used to treat advanced kidney cancer or as adjuvant therapy after surgery.

- VEGF Inhibitors: Bevacizumab (Avastin), when combined with IFN-alpha therapy, helps treat metastatic kidney cancer. It inhibits vascular endothelial growth factor (VEGF) which signals formation of new blood vessels that tumors need to grow.

Immune Checkpoint Inhibitors

The immune system plays an important role in fighting cancer. However, sometimes tumors develop ways to avoid detection by white blood cells. Immune checkpoint inhibitors help overcome these mechanisms. Those approved for kidney cancer include:

- Nivolumab (Opdivo): An anti-PD-1 drug that blocks the PD-1 protein on T-cells, countering the tumor's immune-evading tactics. It treats advanced kidney cancer after prior anti-angiogenic treatment.

- Pembrolizumab (Keytruda): Another anti-PD-1 drug used as second-line treatment in advanced kidney cancer.

- Avelumab (Bavencio): The first immunotherapy approved as front-line maintenance treatment in advanced RCC. It targets the PD-L1 protein to boost antitumor immune response.

Chemotherapy Drugs

While chemotherapy is not very effective against kidney cancer, some drugs may help when other therapies stop working. 5-Fluorouracil and Doxorubicin are commonly used but have only modest response rates of about 20%. Capecitabine (Xeloda) has also shown activity against kidney cancer. These should only be considered after trying targeted or immunotherapy options.

Adjuvant and Neoadjuvant Therapy

Drug therapy is also used alongside other primary kidney cancer treatments. Adjuvant therapy administers drugs after main treatment like surgery, to lower the risk of recurrence. Sunitinib and Pazopanib are approved as adjuvant treatment after surgery in high-risk RCC.

Neoadjuvant therapy uses drugs before the main treatment to shrink tumors and improve surgical outcomes. Tyrosine kinase inhibitors are being studied in a neoadjuvant setting prior to kidney tumor removal. This includes research combining VEGFR TKIs with PD-1/PD-L1 inhibitors to maximize immune sensitization of tumors.

Multi-disciplinary treatment planning is essential to select the right drug combination tailored to individual factors like stage, risk level, and underlying genetic make-up of each patient's cancer. Ongoing clinical trials continue exploring newer targeted agents and immunotherapies for kidney cancer. Precision medicines targeted against specific genetic mutations may further optimize outcomes in the future.

Adverse Effects of Kidney Cancer Drugs

While anti-cancer medications improve survival, they can also cause adverse effects requiring careful management. Common side effects of targeted and immunotherapy drugs include fatigue, rash, diarrhea, nausea, mouth sores and low blood cell counts.

Some TKIs like Sunitinib may more frequently cause hand-foot syndrome, high blood pressure and cardiotoxicity. Rare but serious risks include pneumonitis, colitis and kidney dysfunction with immunotherapies like nivolumab. Patients on oral chemotherapy or targeted therapy require monitoring of liver and thyroid function as well.

Careful follow-up and supportive care helps mitigate side effects. Dose reductions, treatment breaks or switching drugs may become necessary depending on toxicity. Quality of life is a priority alongside cancer control. With close communication between treating physicians and prompt symptom management, most patients are able to complete prescribed drug regimens.

Overall kidney cancer treatment has come a long way with new drug discoveries revolutionizing management. Precision use of targeted and immune drugs at appropriate stages aims to deliver maximum survival benefits while preserving patient well-being. Further research continues developing even more powerful treatments for this formidable disease.
 
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