Combination Therapy for Metastatic Renal Cell Carcinoma

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:

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:

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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.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on February 10, 2019

Sources

SOURCES:

ASCO Genitourinary Cancers: “Emerging Role of Combination Immunotherapy Regimens in Metastatic Renal Cell Carcinoma.”

The Oncologist: “Targeted Therapies for the Treatment of Metastatic Renal Cell Carcinoma: Clinical Evidence.”

Annals of Translational Medicine: “Combination therapy for metastatic renal cell carcinoma.”

FDA: “Lenvatinib in combination with Everolimus.”

American Cancer Society: “Targeted therapies for kidney cancer.”

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