Anti-cancer medications (medication to treat the cancer) aim to reduce symptoms and prolong life. They might kill cancer cells, stop or slow down tumour growth, or shrink
tumours. Chemotherapy is not used in kidney cancer. Most anti-cancer medications for metastatic RCC are targeted therapies or immunotherapies.

Targeted therapy blocks specific signals within the cancer. One strategy is to interfere with blood supply to the cancer, which slows or stops the growth of the tumour, and sometimes causes it to shrink. This group of drugs are called “tyrosine kinase inhibitors”. The tyrosine kinase inhibitors used to treat kidney cancer are: axitinib, bevacizumab, cabozantinib, lenvatinib, pazopanib, sorafenib, sunitinib. Only bevacizumab, is an intravenous targeted therapy; the rest are pills.

A second group of medicines for kidney cancer called mTOR inhibitors work by blocking a protein called mTOR that normally helps cells grow and divide, but can be overactive in cancer . The mTOR inhibitors used to treat kidney cancer are everolimus (pill) and temsirolimus (intravenous).

Finally, the newest targeted therapy to show effectiveness against kidney tumours is belzutifan (pill). It works by blocking a protein called HIF-2 that controls both cancer cell growth and formation of new blood vessels. Currently, belzutifan is only indicated for kidney cancer caused by von Hippel-Lindau disease, but clinical trials are investigating it in a variety of treatment settings for advanced kidney cancer.

New clinical trials are underway to determine if other types of cell signalling can be turned off to prevent the growth of kidney cancer. One potential targeted therapy called savolitinib is a MET inhibitor that is being studied in certain genetically-selected patients with papillary renal cell carcinoma. Other new types of inhibitors are in clinical trials for kidney cancer.

Treatments change frequently, so be sure to ask your patient support organisation what is available in your country. Some anti-cancer medications are taken as tablets or capsules, while some are injected just under the skin (subcutaneously) or into a vein (intravenously). If you take tablets or capsules, you will take them at home according to a regular schedule. You or your carer can also be taught how to do subcutaneous injections at home. Intravenous anti-cancer medication is administered by a nurse in the hospital every 2-4 weeks during an outpatient clinic appointment.

Anti-cancer medication may be the only treatment you receive, or it might be used in combination with surgery or radiotherapy. Different types of anti-cancer medication can also be combined to improve its effectiveness at treating the cancer.

Possible side effects of anti-cancer medications

Each anti-cancer medication for metastatic RCC has different possible side effects. Not everybody will have side effects. If they do occur, they may be mild or temporary, but others may be serious and long lasting and need medical attention. If you take anti-cancer medication and notice any side effects, do not wait – tell your healthcare professional immediately. Early reporting can help to minimise the impact of side effects on your health and quality of life and may help you stay on medication longer. Your doctor can discuss with you the possible side effects of anti-cancer medications available to you. The following tables list the main types of anti-cancer medications used to treat metastatic RCC.

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