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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017

Targeted therapy

Targeted therapy is treatment with drugs that target

a specific or unique feature of cancer cells. These

drugs stop the action of molecules that help cancer

cells grow. Targeted therapy is used to treat kidney

cancer that has spread to other parts of the body. In

the past 10 years, many targeted therapy drugs have

been approved to treat advanced kidney cancer.

Targeted therapy drugs treat kidney cancer in a few

different ways. Some target and block the signals

that cause new blood vessels to form. Others block

the signals that tell the kidney cancer cells to grow

and make more cancer cells. Often, these drugs

have more than one target. The different types of

targeted therapy are named based on what they



Bevacizumab is a type of targeted therapy called an

angiogenesis inhibitor. Angiogenesis is the growth

of new blood vessels. Like normal cells, cancer

cells need the food and oxygen in blood to grow.

Kidney cancer cells are very good at getting new

blood vessels to grow into the tumor to “feed” it. The

cancer cells release high amounts of a protein called









actor). VEGF

binds to receptors on cells that form blood vessels.

The binding sets off signals in the cells for new blood

vessels to grow into the tumor.

Bevacizumab attaches to VEGF, which stops VEGF

from binding to receptors on cells. This stops VEGF

from sending signals for new blood vessels to form.

Thus, bevacizumab slows or stops blood vessel

growth and “starves” the tumor.

Bevacizumab is a liquid that is given by infusion.

Infusion is a method of giving drugs slowly through

a needle into a vein. It takes about 90 minutes to

get the first dose and 30 minutes for later doses.

It may be given alone or with interferon alfa, an

immunotherapy drug (described on page 37).

Although bevacizumab targets tumor blood vessels,

it can also affect normal blood vessels. This can

result in side effects. A side effect is an unhealthy or

unpleasant physical or emotional condition caused

by treatment. Some side effects can be very serious

while others can be unpleasant but not serious.

Some common side effects of bevacizumab are high

blood pressure, headache, nosebleeds, runny nose,

taste changes, skin rash, dry skin, and back pain.

Rare but serious side effects include stroke, heart

attack, kidney damage, holes in the intestine, and

bleeding within the body.

Sorafenib, sunitinib, pazopanib, axitinib,

cabozantinib, and lenvatinib

Sorafenib, sunitinib, pazopanib, axitinib,

cabozantinib, and lenvatinib are types of targeted

therapy called TKIs (







Tyrosine kinases are proteins in cells that are

important for many cell functions. This includes

sending signals in cells for cell growth, survival, and


TKIs bind to tyrosine kinases in cells to block the

signals that help kidney cancer grow and spread.

There are many different types of tyrosine kinases.

Some tyrosine kinases send signals that tell cancer

cells to grow and divide to make new cells. Some

tyrosine kinases send signals that tell new blood

vessels to grow into the tumor.

Each TKI works in a slightly different way. Some

TKIs target and block more than one type of tyrosine

kinase. These are called multi-kinase inhibitors.


Overview of cancer treatments

Targeted therapy