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  • Other Treatments for Kidney Cancer: Biologic Therapy and Targeted Therapy

    Biologic therapy may be used in the treatment of kidney cancer that has spread.

    Biologic Therapy

    Biologic therapy is a treatment that uses drugs to improve the way your body’s immune system fights disease. Your immune system is your body’s natural defense against disease. Biologic therapy attempts to repair, stimulate, or enhance the immune system so that it can fight the cancer more effectively. These therapies can be used to fight cancer or to lessen the side effects that may be caused by some cancer treatments.
    Examples of agents used to treat kidney cancer include interferon and interleukin 2 (also known as IL-2, aldesleukin, or proleukin). Doctors are investigating using interferons with other biologic agents.
    Interleukin 2 (IL-2) is approved for metastatic kidney cancer, when the disease has spread to other places in the body. The medicine is given either subcutaneously (shots under the skin) or intravenously (by vein) either in the hospital or in an outpatient setting. Treatment may be given in cycles separated by a rest period. Although only about one in six patients with renal cell carcinoma have shrinkage of their cancer with IL-2, some of these patients have disappearance of their cancer (complete remission) that can be long-lasting. Unfortunately, the medicine has many side effects and is not appropriate for all patients with renal cell carcinoma.
    A combination treatment of bevacizumab (Avastin) and interferon-alpha is used for patients with kidney cancer that has spread to other parts of the body. The medicines are given intravenously and work by preventing the growth of new blood vessels to the tumor. The drugs were approved after clinical trials showed an increase of five months in survival rate versus interferon-alpha alone. Tumor size also decreased 30% with the combination medicines, versus 12% with interferon-alpha alone. The most common side effects are hypertension and gastrointestinal bleeding or perforation.
    Effectiveness
    Interleukin 2 produces responses in 15% of kidney cancer patients. Interferon response rate is about 15%. The combination of interferon with other chemotherapy drugs and IL-2 increases the response rate.
    Side Effects
    Research shows adverse events occur in the majority of patients. The percentages of people experiencing common adverse events of IL-2 are as follows:
    • Chills: 52%
    • Fever: 29%
    • Low blood pressure: 71%
    • Diarrhea : 67%
    • Vomiting: 50%
    • Rash: 42%
    • Shortness of breath: 43%
    Side effects for the bevacizumab and interferon alpha combination included:
    • Fatigue
    • Weakness
    • Protein in the urine
    • High blood pressure
    • Bleeding
    Targeted Therapy
    This new class of medicines attempts to interfere with the growth of the tumor by blocking the formation of new blood vessels around the tumor. In recent months, this drug has received FDA approval.
    Sorafenib (Nexavar) is a new medicine that targets several different pathways of tumor growth. The most common side effects seen with this drug include:
    • Rash
    • Diarrhea
    • Hypertension
    • Redness
    • Pain
    • Swelling
    • Blisters on the palms of the hands or soles of the feet
    • Nerve damage
    This medicine is given in the form of a pill.
    Taken in pill form, sunitinib (Sutent) attacks both blood vessel growth and other targets that stimulate cancer cell growth. The results show tumor shrinkage in one third of the patients treated. The most common side effects are diarrhea, change in skin color, mouth irritation, weakness, and altered taste. Other possible effects include tiredness, hypertension, bleeding, and hypothyroidism .
    Temsirolimus (Torisel) is an intravenous medicine used in advanced kidney cancer, which also works to inhibit cell growth. The most common side effects include:
    • Skin rash
    • Feeling weak
    • Mouth irritation
    • Nausea
    • Loss of appetite
    • Fluid buildup in the face or legs
    • Increases in blood sugar and cholesterol levels
    Pazopanib (Votrient) is approved for the treatment of advanced kidney cancer. It is taken once a day as a pill either an hour before eating or two hours after eating. It works by preventing the growth of new blood vessels to tumors. The most common side effects include:

    References

    American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp?level=0 .

    Avastin approved for kidney cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/NWS/content/NWS%5F1%5F1x%5FAvastin%5FApproved%5Ffor%5FKidney%5FCancer.asp . Accessed December 15, 2009.

    Bast R, Kufe D, Pollock R, et al, eds. Cancer Medicine. 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.

    Escudier B, Eisen T, Standler WM, et al. Sorafenid in advanced clear-cell renal cancer carcinoma. N Engl Med. 2007; 356:125

    FDA approval for pazopanib hydrochloride. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/druginfo/fda-pazopanibhydrochloride . Accessed December 15, 2009.

    FDA approves Avastin plus interferon-alfa for people with metastaic renal cell carcinoma. The Medical News website. Available at: http://www.news-medical.net/news/20090803/FDA-approves-Avastin-plus-interferon-alfa-for-people-with-metastatic-renal-cell-carcinoma.aspx . Accessed December 15, 2009.

    Kidney Cancer Association website. Available at: http://www.kidneycancerassociation.org/ .

    Mosby's Drug Consult. St. Louis, MO: Mosby, Inc; 2002.

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

    Rakel R. Bope E, ed. Conn's Current Therapy. 54th ed. St. Louis, MO: WB Saunders; 2002: 721-722.

    Rini BI, Halabi S, Rosenberg JE, et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal cell carcinoma: final results of CALGB 90206. J Clin Oncol . 2010 May 1;28(13):2137-43.

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