Targeted therapies are relatively new for treating renal cell carcinoma (RCC). They have a more focused mechanism of action than chemotherapy and are proving to be important in diseases where chemotherapy is not effective. These drugs are often used as first- and second-line treatments against advanced RCC, including stage IV, relapsed, or cancer that cannot be surgically removed. While complete remissions are rare, these agents may shrink tumors and control their growth for long periods. Learn about possible side effects of targeted therapies.
As of now, targeted drugs are most often used one at a time. If one doesn't work, another may be tried. Clinical studies are being done to determine if combining targeted therapies, either with each other or with other types of treatment, might be more helpful than giving them one at a time. The potential of giving these drugs before or after surgery is also being studied.
Sunitinib, a tyrosine kinase inhibitor, blocks several tyrosine kinases. It works by preventing the growth of new blood vessels that tumors need to grown (anti-angiogenesis) and blocking cells from dividing and multiplying. It is usually taken as a pill once per day for a four-week cycle, with two weeks off in between cycles. The most common side effects are nausea, constipation or diarrhea, changes in skin or hair color, mouth sores, weakness, and low white and red blood cell counts. Other possible effects include tiredness, high blood pressure, congestive heart failure, bleeding, hand-foot syndrome, and low thyroid hormone levels.
Bevacizumab is an anti-angiogenesis drug that is usually used in combination with interferon-alpha for renal cell carcinoma that has spread to another part of the body. It is an IV drug that is given every 14 days. Bevacizumab is usually tolerated well by patients, but it can cause serious side effects such as increases in blood pressure, bleeding or blood clotting problems, and wound healing problems.
Pazopanib is another tyrosine kinase inhibitor and anti-angiogenesis drug. It is taken as a pill once a day. Common side effects include high blood pressure, nausea, diarrhea, headaches, low blood cell counts, and liver problems. Like bevacizumab, problems with bleeding, clotting, and wound healing may also occur. On rare occasions, its use may lead to severe liver damage that can be life threatening. If you are on this drug, your doctor will monitor your blood tests for liver or other problems.
Temsirolimus blocks the mTOR signaling molecule, resulting in the death of tumor cells (apoptosis) and anti-angiogenic effects. It is given as an intravenous (IV) infusion once a week. The most common side effects of this drug include skin rash, weakness, mouth sores, nausea, loss of appetite, swelling in the face or legs, and increases in blood sugar and cholesterol levels. A less common but serious side effect is damage to the lungs, which can cause shortness of breath or other problems
Sorafenib, which is usually taken twice a day as a pill, is a tyrosine kinase inhibitor that has anti-angiogenic effects. The most common side effects seen with this drug include tiredness (fatigue), rash, constipation or diarrhea, increase in blood pressure, and redness, pain, swelling, or blisters on the palms of the hands or soles of the feet (hand-foot syndrome).
This drug also blocks mTOR and is typically used after other drugs such as sorafenib or sunitinib have been tried. It is taken as a pill once a day. Common side effects of this drug include mouth sores, increased risk of infections, nausea, loss of appetite, diarrhea, skin rash, feeling tired or weak, swelling (usually in the legs), and increases in blood sugar and cholesterol levels. A less common but serious side effect is damage to the lungs, which can cause shortness of breath or other problems.
This drug, which also inhibits tyrosine kinases, is used for people who have not responded to other medications. It is taken as a pill twice a day. Common side effects include high blood pressure, fatigue, nausea and vomiting, diarrhea, poor appetite and weight loss, voice changes, hand-foot syndrome, and constipation. Again, as with bevacizumab, there may be problems with bleeding, clotting, and wound healing. Axitinib, like other tyrosine kinase inhibitors used to treat RCC, may also cause the thyroid gland to become underactive, so your doctor will watch your blood levels of thyroid hormone while you are on this drug.
The side effects vary greatly from person to person and depend on the type and dose of drug(s) given, how they are given, and the length of time they are taken. Some people experience few, if any, side effects. Your doctor may give you medicines to lessen the severity of side effects or prevent them before they happen. Read about symptom management in our medical support section for more information.
The time it takes to get over some side effects and regain energy depends on many factors, including your overall health and your treatment.
Your doctor or nurse can tell you the side effects that are most common with your treatment, how long they might last, and how bad they might be. Promptly report side effects to your medical team so they can be treated. Your doctor or nurse may be able to suggest ways to reduce pain and discomfort or may change your medicine or treatment schedule. In some cases, the dose may need to be reduced or treatment may need to be delayed or stopped to prevent the side effects from getting worse.