What is immunotherapy?

Immunotherapy is a treatment that uses medicines to kill cancer cells or slow their growth. It's not the same as chemotherapy, which doesn't work well for kidney cancer. Immunotherapy works in different ways and causes different side effects.

Immunotherapy is also called biologic therapy. This cancer treatment works with your body’s own immune system to find and kill cancer cells. These medicines boost, focus, or restore certain parts of the immune system.

When might immunotherapy be used for kidney cancer?

Your healthcare provider may suggest these treatments if the cancer has spread beyond your kidney or comes back after treatment. 

There are different kinds of immunotherapy medicines. This treatment can be used together with targeted therapy. Targeted therapy uses medicines that target certain parts of some cancer cells. They alter the cancer cells' ability to grow and survive.

How is immunotherapy given for kidney cancer?

This treatment may be given by mouth, shots (injections), or right into your blood through an IV (intravenous) line.

There are 2 main groups of immunotherapy medicines: immune checkpoint inhibitors and cytokines.

Immune checkpoint inhibitors

These medicines help your immune system find and kill cancer cells. Sometimes kidney cancer cells use certain proteins, called checkpoints, to keep your immune system from attacking them. Examples of checkpoints are CTLA-4, PD-1, and PD-L1. Medicines that block these checkpoints can boost your immune system against these cancer cells. This can shrink some tumors or slow their growth. Immune checkpoint inhibitors are monoclonal antibodies that target immune checkpoints.

Immune checkpoint inhibitors that might be used include:

• Nivolumab

• Pembrolizumab

• Ipilimumab

• Avelumab

All of these are given as IV infusions every 2, 3, or 4 weeks. This will depend on the treatment regimen given.

Cytokines

Cytokines are small proteins the body makes to help boost the immune system. Manmade versions of these proteins can be used to treat kidney cancer. They act like the natural proteins to turn on the immune system. They might be used if other immunotherapy medicines or targeted therapy don't work.

The cytokines that might be used are:

• Interleukin-2 (IL-2). Interleukin-2 is given as an IV infusion. Low doses may be given as outpatient therapy, but high doses work better. High-dose IL-2 can cause serious side effects. It's only given at cancer centers that have a lot of experience with this treatment.

• Interferon alpha. Interferon alpha doesn't work as well as IL-2. It's most commonly given along with the targeted therapy medicine called bevacizumab. It's common to take this medicine for many years, as long as it's working and the side effects aren't too severe. It's given as an injection a few times a week. You can get it as an outpatient at a hospital, clinic, or healthcare provider’s office. This means you go home the same day. Or you may learn how to give it to yourself at home. 

What are possible side effects of immunotherapy?

Even though some of these medicines are taken by mouth at home, like most types of cancer treatment, they can cause side effects. Some can be severe. Side effects depend on the type and dose of medicines you’re taking. If you are treated with more than 1 medicine, you will most likely have more side effects.

Side effects tend to get better over time after treatment ends. They vary from person to person. Many of them can be treated to keep them from getting worse. It's important to tell your treatment team about any changes you notice while getting immunotherapy.

Possible side effects include:

• Appetite loss

• Mouth sores

• Extreme tiredness and weakness

• Headaches, muscle aches, joint aches, or bone pain

• Nausea and vomiting

• Skin rash or dryness, itching

• Pain, redness, swelling, and blistering of the skin on your palms and the soles of your feet (called hand-foot syndrome)

• Changes in skin and/or hair color

• Constipation

• Fluid buildup that may cause swelling

• Easy bleeding and bruising

• Low thyroid hormone levels

Serious side effects can include:

• Changes in mental function

• Low or high blood pressure

• Diarrhea

• Pain in the belly (abdomen)

• Chills with a high fever

• High blood sugars

• Fast heartbeat

• Heart rhythm changes

• Slow wound healing

Other, less common, but severe side effects are possible, such as:

• Heart attack

• Heart failure

• Bleeding and holes in the intestines

• Blood clots

• Fluid buildup in the lungs

• Trouble breathing

• Kidney damage

• Liver damage

In rare cases, some of these side effects can be fatal. Because of the risk of severe side effects, these treatments are not an option for everyone. They're used to treat kidney cancer only in people who are in good overall health and who can cope with treatment-related problems.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, many of these medicines can cause diarrhea. You may be told to drink a lot of fluids, not eat high-fiber foods, and call if you have 4 or more loose bowel movements a day for more than 2 days.

Make sure you know what number to call with questions or problems. Is there a different number to call after hours when the clinic is closed, or on weekends and holidays?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.