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Cancer needs a good blood supply to bring food and oxygen and remove waste products. In order to grow larger than one or two mm a tumour needs its own blood supply. Some cancers produce VEGF (vascular endothelial growth factor) which attaches to receptors on the wall of the blood vessel and triggers blood vessel growth. Angiogenesis means the growth of new blood vessels. Stopping angiogenesis can stop tumours growing and can shrink them. Some targeted therapies aim to do this.
Tyrosine kinase inhibitors (TKI’s) block the VEGF receptor on the blood vessel; acting to stop the blood vessel growth signal. TKI’s include pazopanib, sunitinib, axitinib and sorafenib.
mTOR inhibitors. mTOR is a type of protein called a kinase protein. It can make cells produce chemicals such as cyclins that trigger cell growth. It may also make cells produce proteins that trigger the development of new blood vessels. Inhibiting this pathway may reduce cell growth and blood vessel formation. mTOR inhibitors include everolimus and temsirolimus.
The Monoclonal antibody bevacizumab blocks VEGF and has an anti-angiogenic action (stops blood vessel formation).
Targeted therapies that have been used for kidney cancer include pazopanib, sunitinib, axitinib, everolimus, temsirolimus, sorafenib and bevacizumab. However, not all of these drugs are routinely used or funded within the NHS. NICE only recommend pazopanib and sunitinib as a first-line treatment of advanced kidney cancer. Axitinib is the only drug recommended for use as a second-line treatment after failure of prior systemic treatment (Nivolumab is also recommended as a second line treatment option. More details about this drug can be found in the immunotherapy/monoclonal antibody section).
For more details on their effectiveness, side-effects, mechanism of action, dosage and safety, please view the downloadable targeted therapy chart. Hopefully the information provided will help you discuss treatment options with your doctor.
Interferon Alpha-2a
Interferon alpha is a man-made copy of a substance that some types of white blood cell make naturally in the body. Blood cells make interferon as part of an immune response when the body reacts to infection or cancer. Giving interferon may stimulate the body to fight the cancer. Not many people can tolerate this treatment due to the strong side-effects and it is rarely given as a treatment now. It is not recommended by NICE.
Learn more about interferon treatment in the downloadable chart.
Interleukin 2
Interleukin-2 is a man-made copy of a substance that some types of white blood cell make naturally in the body. Blood cells make interleukin as part of an immune response when the body reacts to infection or cancer. Giving interleukin may stimulate the body to fight the cancer. Not many people can tolerate this treatment due to the strong side-effects and it is rarely given as a treatment now. It is not recommended by NICE.
Learn more about interleukin-2 treatment in the downloadable chart.
Monoclonal Antibodies
Nivolumab (Opdivo) is a monoclonal antibody which acts to block and stop the activation of PD-1 receptors on immune cells. PD-1 receptors if activated, reduce the ability of immune cells to function and destroy cancer cells. Cancer cells themselves produce PD-1 and inhibit the immune system. Nivolumab acts to enhance the body’s own immune function by lifting this inhibition, allowing the immune system to destroy more cancer cells.
Nivolumab is recommended by NICE for use as a second line treatment.
Download the immunotherapy chart for more details on Nivolumab.
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