Biological therapy drugs for kidney cancer

Interferon is a type of biological therapy known as immunotherapy. It works in several ways:

• It can directly help to stop the cancer cells growing
• It may also boost the immune system to attack the cancer
• It may restrict the blood supply to the cancer cells.

You are most likely to have interferon for kidney cancer that has spread. If you have more than one area of cancer spread in the same organ, it is unlikely to be possible to remove the cancer surgically and your doctor may consider treating you with interferon. It can help to control or stabilise the cancer, rather than make it disappear altogether. Interferon treatment has been shown to help patients with advanced kidney cancer, particularly when the cancer has spread to the lung. People who benefited most from this treatment were in good general health, with few cancer symptoms.

The type of interferon used for kidney cancer is called interferon-2a (Roferon-A). You usually have it 3 times a week, as a small injection just under the skin. You, a friend, or a relative can be taught how to give these injections at home or you can have them done by your GP practice nurse, or a district nurse.

The most common side effects of interferon are flu-like symptoms during the first week or two of treatment. Taking paracetamol half an hour before your injection can help to prevent or reduce these side effects. Some people also feel sick, lose their appetite and feel very tired. Some people find that interferon can make them feel low in spirits or even depressed. There is more information about specific side effects of interferon on CancerHelp UK.

Interleukin is also called IL-2 or aldesleukin. It is produced naturally in the body as part of our immune system. It usually works to stimulate white blood cells (lymphocytes) to fight infection. IL-2 can now be made in laboratories. IL-2 is most often used for advanced kidney cancer.

IL-2 is used on its own or in combination with other treatments. A trial is comparing interferon on its own with a combination of interferon, IL-2 and a chemotherapy drug called fluorouracil for advanced kidney cancer. IL-2 is also being tried as a treatment after surgery for early kidney cancer. The aim of this treatment is to try to lower the chance of the cancer coming back. Doctors call this adjuvant treatment. Both these trials are closed and we are waiting for the results. 

The side effects of aldesleukin vary, depending on the dose you are having. They can be very severe with high dose treatment. You should only have this drug given to you in specialist centres, by doctors experienced in using it. The side effects are similar to those of interferon, but likely to be worse and some people also have aches and pains in their joints, changes to the pattern of their heart beat, and fluid on the heart or lungs.

There is a page on the specific side effects of aldesleukin in CancerHelp UK.

Sunitinib is also called Sutent. It comes as a capsule, which you swallow. It is a type of drug called a tyrosine kinase inhibitor or TKI for short. It blocks tyrosine kinase in cancer cells. Tyrosine kinase is a chemical messenger (an enzyme) that sends messages to tell cells to divide and grow.

Research trials have shown that sunitinib can stop or slow the growth of advanced kidney cancer. The side effects include tiredness, diarrhoea, a sore mouth and changed taste, as well as a raised blood pressure. We have detailed information about the side effects of sunitinib.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance that sunitinib should be available as a treatment option for people with advanced kidney cancer, if they would be suitable for biological therapy treatment and are reasonably fit (for example, well enough to do light house work).

Other biological treatments are being used for kidney cancer. Pazopanib is a type of tyrosine kinase inhibitor (a multi-TKI). It works by blocking certain proteins called vascular endothelial growth factors (VEGFs). These are natural body chemicals that control cell growth. Blocking the growth factors may stop cancer growing. Researchers have found that it can help people who have advanced kidney cancer live longer. In January 2011, NICE said it should be available within the NHS in England as a treatment for people with advanced kidney cancer under certain conditions. This means it is only available under the patient access scheme so the company making it reduces the price of the drug to the NHS. NICE also say that you must not have had any other type of growth factor treatment before and you must be either symptom free or well enough to do things such as light housework. 

Bevacizumab (Avastin), sorafenib (Nexavar), everolimus (Afinitor) and temsirolimus (Torisel) have been shown to stop or slow the growth of advanced kidney cancer but the National Institute for Health and Clinical Excellence (NICE) have given guidance that they are currently too expensive for the amount of benefit they give. So they are not widely available on the NHS. You may have them as part of clinical trials.

Other treatments are in early research and we have only briefly mentioned them here because they are still very much at the investigation stage and so are not available outside clinical trials. For more detailed information, look at the kidney cancer research page.

Other biological treatments being developed include

• Vaccines
• New immunotherapy drugs
• Drugs to stop tumours making blood vessels

Vaccines

Vaccines can be made from tumour cells or dendritic cells. Tumour cell vaccines are made from each individual patient’s kidney cancer cells, removed during surgery. Dendritic cells are a type of white blood cell. They are removed from the blood and mixed with kidney cancer cells in a laboratory. Then, they are injected back into the patient as a vaccine.

New immunotherapy drugs

Immunotherapy drugs are drugs that work in a similar way to interferon and IL-2. They include GM-CSF (a growth factor that tells the body to grow white blood cells) and IL-12 (another ‘chemical messenger’ of the body’s immune system).

Drugs to stop tumours making blood vessels

Treatments that stop tumours making blood vessels are called anti-angiogenics. One drug used to do this is thalidomide. Thalidomide has been tested in combination with interferon and IL2 for advanced kidney cancer.