When kidney cancer spreads to the lungs, it is termed metastatic renal cell carcinoma. This advanced stage means cancer cells have traveled through the bloodstream or lymphatic system to establish new tumors in the lung tissue. While this presents a complex health challenge, advancements in medical therapies offer a range of options. Treatment is highly individualized to each patient’s unique condition.
Understanding the Treatment Approach
Treating kidney cancer that has spread to the lungs involves several goals: controlling tumor growth, extending life, alleviating symptoms, and improving quality of life. Achieving these objectives often requires a collaborative effort from a multidisciplinary team. This team typically comprises medical oncologists, radiation oncologists, and thoracic surgeons, working together to develop a comprehensive and tailored treatment plan.
Treatment decisions are personalized, considering factors specific to each individual. These include the patient’s general health, the number and locations of lung metastases, previous treatments, and the cancer cells’ characteristics, such as their type and genetic makeup.
Systemic Therapies
Systemic therapies affect cancer cells throughout the entire body, providing a widespread approach to treatment. This category primarily includes targeted therapies and immunotherapy, central to managing metastatic kidney cancer.
Targeted therapies interfere with specific molecules involved in cancer cell growth and spread. Tyrosine kinase inhibitors (TKIs) block proteins that regulate cell growth and division, and can inhibit new blood vessel formation (angiogenesis). Examples include sunitinib, pazopanib, axitinib, and cabozantinib, often taken orally. Common side effects include fatigue, nausea, mouth sores, diarrhea, skin rashes, and high blood pressure. Another targeted therapy, mTOR inhibitors (e.g., everolimus, temsirolimus), block the mTOR pathway, which promotes cell proliferation. Side effects can include stomatitis (sore mouth) and pneumonitis (lung inflammation).
Immunotherapy harnesses the body’s immune system to recognize and destroy cancer cells. Immune checkpoint inhibitors block proteins (e.g., PD-1, PD-L1, CTLA-4) that normally prevent immune cells from attacking cancer. By releasing these “brakes,” drugs like nivolumab, pembrolizumab, ipilimumab, and avelumab enable immune cells to better target and eliminate cancer. While effective, these therapies can lead to immune-related side effects as the activated immune system may also affect healthy tissues. These can manifest as fatigue, skin rashes, diarrhea, or inflammation in various organs like the lungs, intestines, or hormone-producing glands.
Chemotherapy, a traditional cancer treatment, is generally less effective for renal cell carcinoma compared to targeted therapies and immunotherapy. It may be considered for specific, less common types of kidney cancer or when other systemic therapies have not been successful.
Localized Treatments for Lung Metastases
Localized treatments focus on cancerous tumors within the lungs, aiming to remove or destroy them directly. These approaches are useful when metastases are limited in number or size.
Surgical removal, known as metastasectomy, is an option for carefully selected patients. This procedure is considered when there are a limited number of lung tumors that can be safely resected, and the patient is in good overall health. The goal of metastasectomy is to remove all visible cancerous tissue from the lungs, potentially offering long-term disease control.
Radiation therapy, particularly Stereotactic Body Radiation Therapy (SBRT), delivers precise, concentrated doses of radiation to lung tumors. This technique destroys cancer cells while minimizing exposure to surrounding healthy lung tissue, reducing side effects. SBRT is often delivered in a few high-dose sessions.
Ablation techniques destroy lung tumors using extreme temperatures. Radiofrequency ablation (RFA) uses heat, while cryoablation uses extreme cold. These methods are less invasive than traditional surgery and may be suitable for smaller lesions, or for patients not candidates for surgical removal due to other health conditions or tumor location.
Combination Strategies and Emerging Options
Combining different types of treatments is a common and often more effective approach for metastatic kidney cancer. This targets cancer cells through multiple pathways, enhancing effectiveness and overcoming resistance. Common combination therapies include pairing two immunotherapies, such as nivolumab and ipilimumab. Another strategy involves combining immunotherapy with a targeted therapy, for instance, pembrolizumab with axitinib, or nivolumab with cabozantinib. These combinations leverage the distinct mechanisms of each drug, with immunotherapy activating the immune response and targeted therapy interfering with cancer cell growth or blood supply. Clinical studies show these combinations can lead to improved outcomes compared to single-agent therapies.
Beyond established treatments, clinical trials offer patients access to new therapies not yet widely available. These research studies test new drugs, combinations, or treatment approaches, offering potential benefits to participants while contributing to the advancement of cancer care. Patients considering clinical trials should discuss these options with their healthcare team to understand the benefits and risks.
Managing Side Effects and Quality of Life
Managing side effects is important for maintaining quality of life during treatment for kidney cancer that has spread to the lungs. Both systemic and localized therapies can cause various side effects requiring proactive management. Common side effects from systemic therapies include fatigue, nausea, skin reactions, and changes in blood pressure. Immunotherapies can also lead to immune-related adverse events, such as inflammation in different organs, which need careful monitoring and prompt intervention. Localized treatments like radiation therapy may cause fatigue, skin issues in the treated area, or temporary respiratory symptoms.
A palliative care team or supportive care services address symptoms and improve comfort throughout treatment. These teams specialize in managing pain, nausea, and other distressing symptoms, and provide emotional and psychological support. Comprehensive care also encompasses nutritional support, appropriate physical activity, and psychological support to help patients cope. Open communication with the healthcare team is essential to effectively manage side effects and ensure the best possible quality of life during treatment.