Kidney cancer treatment has changed a lot in the past few years. One major breakthrough involves immunotherapy — a type of treatment that helps your immune system fight cancer cells more effectively. These medicines are helping people live longer and feel better, even if the cancer has spread or recurred (returned).

If you or someone you love has kidney cancer, learning about immunotherapy can help you understand your treatment options. This article explains what immunotherapy is, how it works, and which types doctors use to treat kidney cancer, including the newest treatments available.

What Is Immunotherapy?

Your immune system helps protect you by finding and destroying harmful invaders like bacteria and viruses. It also looks for abnormal cells that could turn into cancer. But cancer cells can be sneaky — they can hide from the immune system or block its attacks. Immunotherapy is a category of treatment that gives your immune system tools to spot and destroy cancer cells. Think of it as allowing your body to unmask and attack the cancer.

Doctors may suggest immunotherapy in the following situations:

• The cancer is stage 4 and has spread into nearby areas like the adrenal gland, but it can still be removed with surgery.
• The cancer has spread to other parts of the body (called metastatic or stage 4 kidney cancer).
• There’s a high risk that the cancer could come back after surgery. This is called adjuvant therapy and may be used in people with stage 2 or 3 kidney cancer.

FDA-Approved Immunotherapies for Kidney Cancer

The U.S. Food and Drug Administration (FDA) has approved several immunotherapies to treat kidney cancer. These medications work in different ways, but all are designed to help the immune system find and destroy cancer cells.

1. Pembrolizumab

Pembrolizumab (Keytruda), a checkpoint inhibitor, is one of the most widely used immunotherapy drugs. Pembrolizumab blocks a protein called PD-1, which cancer cells use to hide from the immune system. Once PD-1 is blocked, the cells’ disguise is off, and immune cells can attack the tumor. Doctors may use pembrolizumab after surgery or when the cancer has spread to other parts of the body.

2. Nivolumab

Nivolumab (Opdivo), another checkpoint inhibitor that blocks PD-1, helps the immune system stay active so it can fight cancer. Nivolumab is often combined with other drugs to treat advanced kidney cancer, but it can sometimes be used alone.

3. Ipilimumab

Ipilimumab (Yervoy) blocks a different checkpoint called CTLA-4, which slows down immune cells. Using ipilimumab along with nivolumab gives the immune system a double boost to fight cancer more effectively. This drug duo is often used for people with metastatic kidney cancer.

4. Avelumab

Another checkpoint inhibitor, avelumab (Bavencio), targets a protein called PD-L1. This drug helps prompt immune cells to attack cancer. The FDA approved avelumab for use with a targeted therapy called axitinib (Inlyta) as a first-line treatment for advanced renal cell carcinoma.

5. Dostarlimab

Dostarlimab (Jemperli), a PD-1/PD-L1 checkpoint inhibitor, may be used for people with advanced kidney cancer whose tumors have a specific genetic mutation (change) called DNA mismatch repair deficiency. This change makes the cancer more likely to respond to immunotherapy.

6. Cytokines

Cytokines are small proteins that help control the immune system. In the past, cytokines were the main treatment for advanced kidney cancer. They can still help shrink tumors in some people, but newer immunotherapy drugs are usually more effective and are used more often today.

Immunotherapies Being Studied for Kidney Cancer

Researchers are exploring new types of immunotherapy to help people with kidney cancer, especially those whose cancer has stopped responding to earlier treatments. Some of these therapies are showing promise in clinical trials (studies that test new therapies’ safety and effectiveness in humans).

Other Types of Checkpoint Inhibitors

Most current checkpoint inhibitors block PD-1 or CTLA-4 proteins, which cancer uses to hide from the immune system. Scientists are now studying drugs that block other proteins, like TIGIT, LAG-3, and TIM-3. These new targets may help immune cells recognize and attack cancer differently.

Personalized Immunotherapies

Not every treatment works for every person, so some trials are focusing on personalized immunotherapy. Researchers are studying each person’s tumor for biomarkers — clues in blood or tissue samples that help predict which treatments might work best. This personalized approach helps target treatment to people who are more likely to respond.

Experimental Checkpoint Inhibitor Combinations

Some clinical trials are testing entirely new combinations of checkpoint inhibitors for kidney cancer, including some not yet approved by the FDA. These regimens are designed to overcome resistance to earlier therapies and give the immune system a better chance to fight cancer.

Immune-Modulating Agents

These experimental drugs don’t directly block immune checkpoints. Instead, they change the environment around the tumor to help immunotherapy work better. Immune-modulating agents are being tested alongside PD-1 drugs in people with advanced or resistant kidney cancer.

Chimeric Antigen Receptor T-Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy involves changing a person’s immune cells in a lab so the cells can better fight cancer. This cutting-edge treatment is already used for some blood cancers, and researchers are working on ways to make it effective for solid tumors like kidney cancer. CAR T-cell therapy is still in early trials for kidney cancer, but it could become an option in the future.

Targeted Therapies: How They Work With Immunotherapy

Targeted therapies aren’t a type of immunotherapy, but they’re often used with immune-based treatments to fight kidney cancer more effectively. Targeted drugs work by blocking signals that tumors use to grow new blood vessels. Without a blood supply, tumors have a harder time getting the oxygen and nutrients they need to grow.

Targeted therapies used for kidney cancer include:

• Axitinib
• Belzutifan (Welireg)
• Cabozantinib (Cabometyx)
• Lenvatinib (Lenvima)
• Pazopanib (Votrient)
• Sunitinib malate (Sutent)
• Tivozanib (Fotivda)

These medicines are often part of combination treatments that use both targeted drugs and immunotherapy to attack cancer from different angles.

Combination Therapies: Stronger Together

Using more than one type of treatment, like a checkpoint inhibitor plus a targeted therapy, can lead to better results than using either alone. This approach is now a standard option for many people with advanced kidney cancer. Some clinical trials are also testing triple therapy combinations, especially for people with metastatic kidney cancer.

Side Effects of Immunotherapy

Immunotherapy helps your immune system fight cancer, but sometimes it can also cause the immune system to attack healthy tissue. This can lead to side effects — some mild, others more serious.

Common side effects include:

• Tiredness
• Rash or itching
• Diarrhea or stomach problems
• Joint or muscle pain

Less common but serious side effects may include:

• Inflammation in organs such as the lungs, liver, or kidneys
• Irregular heartbeat or chest pain
• Severe allergic reactions

Most side effects can be managed, especially if caught early. Always tell your doctor if you notice any new or unusual symptoms during treatment. Quick action can help keep side effects from getting worse.

Talk to Your Doctor About Immunotherapy

Immunotherapy is changing how doctors treat kidney cancer. Whether you’re newly diagnosed or exploring your next steps, it’s a good idea to ask your doctor if immunotherapy could improve your outcome.

You might ask your oncology team questions like these:

• Are there any FDA-approved immunotherapies that might work for me?
• Am I eligible for any clinical trials near me?
• What side effects should I expect, and how do we weigh them against the possible benefits?

Be open with your cancer specialist about your goals for therapy, personal preferences, and any concerns you have. There’s no one-size-fits-all answer to the question of which is the “best” treatment for kidney cancer, but working closely with your oncologist (cancer doctor) can help you find the right plan for your needs.

It’s also important to let your doctor know if you have trouble sticking with your kidney cancer medication for any reason, including cost. Help is available — read about ways to reduce cost and get financial assistance for kidney cancer treatment.

Meet Others Who Understand

On MyKidneyCancerTeam, the social network for people with kidney cancer and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with kidney cancer.

Are you on immunotherapy for kidney cancer, or have you heard of a new therapy? Share your experience in the comments below, or start a conversation by posting on your Activities page.