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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Overview of cancer treatments



The immune system is the body’s natural defense

against infection and disease. The immune system

includes many chemicals and proteins. These

chemicals and proteins are made naturally in your


Immunotherapy is treatment that increases the

activity of your immune system. By doing so, it

improves your body’s ability to find and destroy

cancer cells. Immunotherapy is used to treat kidney

cancer that has spread to other parts of the body.

Interferon alfa and IL-2 (interleukin-2)

Interferon alfa and IL-2 are proteins called cytokines

that stimulate immune cells. Cytokines are made

naturally in the body as part of the immune system.

But, these proteins can also be made in a lab to use

as treatment for cancer. Thus, interferon alfa and IL-2

are also called cytokine therapy.

Very high doses of IL-2 are used to treat kidney

cancer. This can cause severe and sometimes life-

threatening side effects. Some of the most common

side effects of IL-2 are: low blood pressure, abnormal

kidney and liver function tests, confusion, shortness

of breath, chills, nausea, vomiting, diarrhea, skin

rash, feeling tired or weak, and low urine output.

Rare, but serious side effects include breathing

problems, low blood pressure, kidney damage, fast

heartbeat, coma, bleeding, and infections.

Due to the serious risks, IL-2 is only used for certain

patients who are healthy enough to handle the side

effects. To consider this option, you must have good

overall health. Your kidneys and other organs must

also be working well. High-dose IL-2 should only be

given at a center that has expertise and experience

with this treatment. IL-2 is given as an infusion that

takes about 15 minutes. You will likely need to stay in

the hospital for several days during treatment.

Interferon alfa is not used alone to treat kidney

cancer. It is always given along with bevacizumab, a

targeted therapy drug. Interferon alfa is a liquid that

is injected under the skin with a needle. It is often

given three times a week.

Interferon alfa also has side effects, but not as

severe as IL-2. Side effects of interferon alfa often

include flu-like symptoms such as fever, chills, feeling

tired or weak, headache, and body aches. Other

common side effects are diarrhea, nausea, vomiting,

not feeling hungry, and depression.


Nivolumab is type of drug called a monoclonal

antibody or PD-1 (




eath receptor-



blocking antibody. It attaches to and blocks the action

of the PD-1 protein on T-cells. T-cells are a main

type of white blood cell in the immune system. By

blocking PD-1, the immune system can then go after

cancer cells. The goal is to stop or slow the growth of


Nivolumab is an infusion given over 60 minutes,

usually every 2 weeks. You will be monitored in

the treatment area during and after the infusion for

any reactions. Your doctor can slow the rate of the

infusion or stop it any time if there is a concern. It is

important to let your doctor know if you experience

any side effects between treatment days. Side effects

of this drug may include feeling extremely tired,

nausea, diarrhea, constipation, not feeling hungry,

mouth sores, skin rash, cough, muscle pain, and joint