• Immunotherapy is used in treating kidney cancer to help your immune system fight off abnormal cells.
  • The main types of immunotherapy for kidney cancer are immune checkpoint inhibitors and cytokines.
  • While immunotherapy can be used in treating advanced kidney cancer, there is a high risk for side effects, which you should discuss with your doctor.
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Immunotherapy is a process in which doctors use certain medications to boost your immune system’s ability to fight off abnormal cells. Doctors use this type of treatment in cancer therapies, including those that help treat kidney cancer.

Depending on your situation, your doctor may recommend immunotherapy as either a first-line or second-line treatment.

However, some of these therapies can pose serious side effects, and their effectiveness may be limited in advanced forms of kidney cancer.

Read on to learn more about the types and effectiveness of immunotherapy available for kidney cancer.

The main types of immunotherapy used specifically for kidney cancer are:

  • Immune checkpoint inhibitors such as CTLA-4, PD-1, and PD-L1 inhibitors
  • Cytokines such as interleukin-2 and interferon-alfa

Learn more about each type and the possible side effects below.

CTLA-4 inhibitors

CTLA-4 inhibitors belong to a group of immunotherapy treatments called immune checkpoint inhibitors.

Checkpoints are types of proteins on cells that help deliver immune responses. Immune checkpoint inhibitors ensure that all checkpoints are working to protect healthy cells from cancerous ones.

Your doctor may recommend CTLA-4 inhibitors to help block CTLA-4 proteins, which usually develop on T cells.

Ipilimumab (Yervoy) is a CTLA-4 inhibitor used for kidney cancer. Doctors may use it as part of a combination treatment with other immune checkpoint inhibitors.

This therapy is delivered via intravenous (IV) infusions up to four times total, with 3 weeks between treatments.

Side effects from CTLA-4 inhibitors may include:

  • fatigue
  • skin rashes
  • itchy skin
  • diarrhea

PD-1 inhibitors

PD-1 is another type of immune checkpoint inhibitor that targets T cells.

Two options are nivolumab (Opdivo) and pembrolizumab (Keytruda). Both of these drugs are delivered via IV with treatments spaced weeks apart, and they may be combined with other treatments.

PD-1 may help slow the growth of kidney cancer cells and expose tumor cells to immune system targeting and cell death, which may decrease tumor size.

Side effects may include:

  • fatigue
  • loss of appetite
  • constipation or diarrhea
  • nausea
  • itchy skin or rash
  • joint pain
  • coughing
  • anemia
  • liver abnormalities

PD-L1 inhibitors

PD-L1 is a protein found in some cancer cells. Blocking this protein with PD-L1 inhibitors may help your immune system shrink cancerous growths or stop further cancerous growths.

Avelumab (Bavencio) is a PD-L1 inhibitor doctors use for kidney cancer. It’s given via IV every 2 weeks and may be combined with other medications.

Possible side effects include:

  • fatigue
  • abdominal pain
  • diarrhea
  • high blood pressure (hypertension)
  • breathing difficulties
  • skin blisters or rashes
  • musculoskeletal pain

Interleukin-2 (IL-2) cytokines

IL-2 is a high dose cancer treatment given via IV. Due to a high risk of side effects, it’s typically used only in advanced kidney cancer that hasn’t responded to other types of immunotherapy.

Aldesleukin (Proleukin) is an example of a cytokine that targets the IL-2/IL-2R pathway.

IL-2 is just one class of cytokines that’s sometimes used to treat kidney cancer in some people. Cytokines are types of proteins that may help boost your immune system, possibly killing cancer cells and decreasing tumor size.

Your doctor will consider whether you are in good enough health to tolerate the side effects, which may include:

  • kidney damage
  • low blood pressure (hypotension)
  • rapid heart rate
  • heart attack
  • intestinal bleeding
  • gastrointestinal concerns
  • breathing difficulties
  • mental changes
  • high fever, sometimes accompanied by chills
  • fluid buildup in your lungs
  • extreme fatigue
  • capillary leak syndrome, a serious side effect of aldesleukin

Interferon-alfa cytokines

Interferon-alfa is another type of cytokine treatment that may be an alternative to IL-2. The downside is that this treatment may not be effective in treating kidney cancer alone.

A doctor may use it as part of a combination drug, which is injected under your skin three times per week.

Side effects from interferon-alfa treatment may include:

  • fatigue
  • fever and chills
  • nausea
  • muscle aches

Stages 1, 2, and 3 are considered early forms of kidney cancer. Most of these cases may be treated with surgery.

If you have stage 4 kidney cancer, which is an advanced stage, your doctor may recommend immunotherapy. This type of treatment is also used in recurrent cancers.

While the previously mentioned immunotherapies may be used for stage 4 kidney cancer, there are some limitations and combination therapies that may be considered. These include:

  • IL-2 cytokines: typically used only if a doctor determines that the possible benefits outweigh the high risk of side effects
  • PD-L1 inhibitor combination therapies: specifically avelumab and a targeted therapy called axitinib (Inlyta)
  • PD-1 inhibitor combination therapies: for example, nivolumab used with another type of targeted therapy called cabozantinib (Cabometyx)

Overall, researchers believe that immune checkpoint inhibitors — particularly PD-1 — may be helpful for advanced clear cell renal cell carcinoma.

Because there are many types of immunotherapy, it’s difficult to give an estimate of the overall success rates for treatment. However, research has helped reveal trends that may improve treatment outlook.

For example, combination therapies that use immunotherapy with a targeted therapy are thought to be more successful in treating advanced kidney cancer than using each treatment individually.

Several studies suggest that combining treatments can improve progression-free survival, the amount of time that people go without their disease worsening.

Many of these trials compare combination immunotherapy treatments to targeted therapy with a tyrosine kinase inhibitor (TKI) medication called sunitinib (Sutent), which discourages tumor growth.

Sunitinib has been used as a first-line therapy for advanced kidney cancer since 2006.

For example, a 2018 study found that combining nivolumab and ipilimumab led to a 75% survival rate at 18 months, while the rate was 60% when using sunitinib alone.

Among the 1,096 people in the study, the median progression-free survival was 11.6 months with the combination treatment and 8.4 months with sunitinib alone.

In a 2019 study funded by Pfizer, researchers compared the combination of avelumab and axitinib with sunitinib alone.

Among the 866 people in the study, the median progression-free survival was 13.8 months with the combination therapy, as compared with 8.4 months with the single treatment.

Another 2019 study, funded by Merck, compared sunitinib treatment with the combination of pembrolizumab and axitinib.

Among the 861 participants, the median progression-free survival was 15.1 months in the pembrolizumab/axitinib group and 11.1 months in the sunitinib group.

IL-2 and interferon-alfa cytokines are thought to possibly shrink kidney cancer cells in only a small percentage of people. Doctors reserve cytokine treatment for cases where other immunotherapies don’t work.

Because they change your immune system’s responses, checkpoint inhibitors may sometimes send your immune system into overdrive. This can lead to damage to organs such as your:

  • liver
  • lungs
  • kidneys
  • intestines
  • thyroid gland

To minimize side effects in these areas of your body, your doctor may prescribe oral corticosteroids.

These immunosuppressants are sometimes used in place of traditional immunotherapy for kidney cancer if you don’t respond well to those types of therapies.

Report any new side effects from immunotherapy to your doctor right away. You might also consider talking with them about complementary approaches to help manage existing side effects, such as:

  • biofeedback
  • meditation and yoga
  • acupuncture
  • massage or reflexology
  • herbs, vitamins, or botanicals
  • dietary changes

Research in the areas of kidney cancer development, diagnosis, and treatment is ongoing.

Recent clinical trials have also looked at the effectiveness of immunotherapies for kidney cancer, along with the combinations of targeted drugs such as axitinib and cabozantinib.

Once the safety of new treatments has been tested in a clinical setting, the Food and Drug Administration (FDA) may approve future kidney cancer therapies.

You might also consider talking with your doctor about the possibility of participating in clinical trials. The National Cancer Institute maintains a list of current clinical trials for kidney cancer treatments.

How successful is immunotherapy for kidney cancer?

The effectiveness of immunotherapy for kidney cancer depends on the type of kidney cancer you have and other personal factors that may affect your outlook.

How long is immunotherapy treatment for kidney cancer?

Different immunotherapy treatments have different guidelines for how long you can use them. They are typically indicated for a set number of treatment cycles, but these vary by drug.

You may be able to use certain treatments until you reach too high a level of toxicity or until they stop being effective against the cancer.

What is the new treatment for kidney cancer in 2023?

The FDA approved belzutifan (Welireg) to treat advanced kidney cancer that has previously been treated with immune checkpoint inhibitors and anti-angiogenic therapies.

Belzutifan is a hypoxia-inducible factor 2-alpha inhibitor.

Immunotherapy may treat kidney cancer by changing the way your immune system responds to cancerous cells. These treatments come in the form of immune checkpoint inhibitors or cytokines.

Sometimes, immunotherapy may be combined with targeted therapies for better outcomes in advanced cancer.

You can talk with your doctor about immunotherapy as a possible kidney cancer treatment option and about the risk of side effects and complications.