NCCN Guidelines for Patients
Kidney Cancer, Version 1.2017
Overview of cancer treatments
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
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