When you’re in the later stages of kidney cancer, or renal cell carcinoma (RCC), your doctor may not be able to predict which medicine will work best for you. Plus, a drug might start to shrink your tumor at first, but stop working over time. With these two challenges in mind, many doctors now give people with the disease multiple drugs at once, called combination therapy.
Why Combine Drugs?
In the past, a doctor might have tried one drug to treat your cancer. If it didn’t help you or stopped working, he would switch you to another medicine. Now, they can carefully mix and match drugs, often trying to target the cancer from two or more directions at once.
In some studies, combining two drugs has worked better than either medication on its own.
Combination Therapies for RCC
When kidney cancer has spread to other parts of the body, surgery usually isn’t a good option. So doctors will start treatment with different kinds of drugs, usually targeted therapies and immunotherapies. The options include:
- Medicines that stop tumors from making new blood vessels, which cuts off their oxygen and nutrient supplies. They include:
- Drugs that block a protein called mTOr, which tumor cells need to grow and divide. They include:
- Those that block other proteins involved in cancer cell growth and blood vessel formation. They include:
- Immunotherapies, which boost the body’s defenses against tumor cells and keep cancer from hiding from your immune system. They include:
Some drugs work so much better when you take them with other drugs that the FDA approved them specifically for combination therapy. For instance, in 2018 the FDA approved the combination therapy of nivolumab and ipilimumab for previously untreated advanced renal cell carcinoma. A study showed that people did better with the two drugs than with sunitinib alone.
In other cases, scientists are testing drugs that the FDA has already approved to see how well they work together.
Researchers are testing many combinations in clinical trials, so it’s hard to list them all, but some promising ones include:
Drawbacks of Combination Therapy
Many RCC drugs can cause some tough side effects on their own. When you take a few of them at once, you can have more issues. So doctors usually give combination therapies only to people with no other major health problems besides their cancer. Even then, some combinations cause so many side effects that many people can’t keep taking them together.
What to Expect on a Combination Therapy
If your doctor recommends a combination therapy, you’ll have to follow the instructions for two or more medicines. Some drugs are pills that you swallow. Others come as shots or infusions that you get through a tube that goes into a vein (an IV). If you’re on a combination therapy, you might have extra medical appointments to get all your therapies.
Once you’ve started treatment, your doctor will keep track of how well the drugs are working and any side effects you have, just as she would on a single therapy.