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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Overview of cancer treatments

Targeted therapy

Sorafenib, sunitinib, pazopanib, axitinib,

cabozantinib, and lenvatinib are multi-kinase

inhibitors. In kidney cancer, the main purpose of

these drugs is to block the signals for blood vessel

growth. Blocking these signals may slow or stop

cancer growth and spread. It may also cause tumors

to shrink.

Axitinib targets and blocks the signals that cause

new blood vessels to grow into the tumor. By

blocking these signals, axitinib “starves” the tumor.

This may slow tumor growth or cause the tumor to


All of these TKIs come as a pill that is swallowed.

Sorafenib and axitinib are taken twice a day.

Sunitinib, pazopanib, and cabozantinib are taken

once a day. Lenvatinib is combined with another drug

to treat kidney cancer. It is given with everolimus,

which is also in pill form, once a day. See the next

section for more information on everolimus.

Each of these drugs can cause side effects. Some

side effects are caused only by one or a few of

the TKIs. Other side effects are caused by all four

TKIs, but may differ in how likely they are to occur.

Some common side effects of TKIs used for kidney

cancer include: skin rash, hand-foot syndrome, hair

thinning, feeling tired or weak, abnormal bleeding,

change in skin or hair color, high blood pressure,

diarrhea, nausea, vomiting, upset stomach, pain in

belly area, mouth sores, taste changes, not feeling

hungry, weight loss, cough, shortness of breath,

voice changes or hoarseness, abnormal liver function

tests, and pain or swelling in the arms or legs.

Everolimus and temsirolimus

Everolimus and temsirolimus are a type of targeted

therapy called mTOR inhibitors. mTOR is a protein

in cells that is important for cell growth and survival.

mTOR moves chemicals, called phosphates, from

one molecule to another. The phosphate “turns on”

the second molecule. By transferring phosphates,

mTOR sends signals that tell cells to grow and


Everolimus and temsirolimus block mTOR from

transferring the phosphate. This stops the cell from

receiving signals to grow and divide. By blocking the

action of mTOR, these drugs slow tumor growth.

Everolimus comes as a pill that is swallowed.

It is taken once a day. It can be given alone or

with the TKI lenvatinib for the treatment of kidney

cancer. Some of the most common side effects of

this everolimus are: feeling tired or weak, cough,

diarrhea, mouth sores, nausea, not feeling hungry,

increased risk of infections, skin rash, and swelling

from fluid buildup. A less common but serious side

effect is lung damage. This can cause shortness of

breath or other problems.

Temsirolimus is given by infusion once a week. The

infusion takes about 30 to 60 minutes. Some people

have an allergic reaction to the infusion. Symptoms

of an allergic reaction include flushing, chest pain,

and trouble breathing. Before the infusion, you will

likely be given medicine to reduce the risk of allergic

reaction. Some other common side effects of this

drug are: nausea, not feeling hungry, mouth sores,

feeling tired or weak, skin rash, and swelling from

fluid buildup.