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53

NCCN Guidelines for Patients

®

:

Kidney Cancer, Version 1.2017

More research is needed to find the best treatment

options for non-clear cell RCC. Thus, treatment on

a clinical trial is the preferred option for patients with

non-clear cell RCC.

For clear cell RCC,

there are several treatment

options to choose from besides a clinical trial. Most

of the options are types of targeted therapy. Sunitinib,

pazopanib, axitinib, and sorafenib are a type of

targeted therapy called TKIs. They block signals in

cells that help kidney cancer grow and spread. Each

TKI works in a slightly different way and can cause

side effects. Each drug may be a good option for

different reasons. Pazopanib and sunitinib are the

preferred option for this stage of disease. Your doctor

will weigh the risks and benefits of each drug to

choose the best option for you.

Another option is to receive bevacizumab and

interferon alfa. Bevacizumab is a type of targeted

therapy called an angiogenesis inhibitor. Interferon

alfa is a type of cytokine therapy (also called

immunotherapy). Interferon alfa works better

against kidney cancer when it’s given along with

bevacizumab. But, each drug has side effects and

they may be more severe when both drugs are given.

Temsirolimus is a type of targeted therapy called an

mTOR inhibitor. It may be a good option for certain

patients, such as those with three or more poor risk

factors. A poor risk factor is something that increases

the risk that cancer will be aggressive and progress

quickly. Poor risk factors include having trouble with

daily activities or work, metastases in two or more

organs, too much calcium in the blood, and starting

drug treatment less than one year after diagnosis.

High-dose IL-2 is another type of cytokine therapy

that may be an option for some patients. Due to the

risk of severe side effects, high-dose IL-2 is not a

good option for everyone.

It is only recommended if your overall health is good,

your organs are working well, and you are able to do

normal daily activities well.

For those patients with clear cell RCC that has

sarcomatoid features a combination of drugs may be

considered. This includes chemotherapy drugs such

as gemcitabine and doxorubicin given together or

gemcitabine with sunitinib.

For non-clear cell RCC

, there are also several

treatment options to choose from. Many of the

options are the same as those recommended

for clear cell RCC. A clinical trial is the preferred

treatment option for non-clear cell RCC. Other

options include kinase inhibitors such as sunitinib

(preferred), axitinib, cabozantinib, pazopanib, and

sorafenib.

Bevacizumab, an angiogenesis inhibitor, and

nivolumab, a monoclonal antibody, may also be

offered. Erlotinib, lenvatinib, everolimus, and

temsirolimus are other recommended options.

Erlotinib is an EGFR inhibitor. Lenvatinib is a kinase

inhibitor and is given with everolimus. Everolimus

and temsirolimus are mTOR inhibitors. mTOR

inhibitors and EGFR inhibitors work in slightly

different ways to block the signals that tell cancer

cells to grow.

Chemotherapy drugs may also be an option for

very rare types of non-clear cell RCC known as

collecting duct and medullary. The combination

of chemotherapy drugs may include carboplatin

with gemcitabine or paclitaxel, or cisplatin with

gemcitabine.

For those patients with non-clear cell and clear cell

RCC that has sarcomatoid features a combination

of drugs may be considered. This includes the

chemotherapy drugs gemcitabine and doxorubicin

given together or gemcitabine with sunitinib.

5

Treatment guide

Stage IV and relapsed kidney cancer