Treating Advanced and Metastatic Renal Cell Cancer

Sometimes renal cell cancer, the most common type of kidney cancer, is found to have spread beyond the kidney — most often to the lungs, bones, liver, or lymph nodes — either at first diagnosis or later. This is more serious, but treatment has improved considerably, and many people live well for years with it. The aim shifts from removing the cancer to controlling it effectively across the whole body.

Renal cell cancer does not usually respond to ordinary chemotherapy. Instead, treatment uses drugs that either release the brakes on the immune system so it can attack the cancer (immunotherapy), or block the signals a cancer uses to grow its blood supply (targeted therapy, often called TKIs). The major advance of recent years has been combining these approaches.

For most people, first-line treatment is now a combination — either two immunotherapy drugs together (a "doublet IO" combination), or an immunotherapy drug paired with a targeted drug (an "IO-TKI" combination). These combinations control the cancer for longer and help people live longer than the older single treatments, and a minority of patients respond very well and for a long time.

When cancer has already spread, the value of removing the affected kidney — an operation called cytoreductive nephrectomy — is more nuanced than it once was. In the past, the kidney was removed routinely before drug treatment. Trial evidence has since refined this.

The CARMENA trial showed that, for many patients, targeted therapy (a TKI) on its own was as effective as removing the kidney first and then giving the same drug — so nephrectomy is no longer automatic. The SURTIME trial explored the timing of surgery, supporting a strategy of starting drug treatment first and reserving surgery for those who respond well and remain fit. Taken together, these trials mean cytoreductive nephrectomy is now a selective, case-by-case decision — considered particularly for patients with good general health, limited spread, or troublesome local symptoms — rather than a routine first step. Surgery may also be used to remove a single site of spread in carefully selected people.

Alongside cancer treatment, supportive care matters a great deal: managing the side effects of immunotherapy and targeted drugs, protecting bone health, staying active, and looking after emotional wellbeing. Many people continue their normal activities for years. Your team can arrange support for any part of this.

A few practical steps help at every stage of treatment for advanced kidney cancer. Bring someone with you to appointments where treatment decisions are made. Write your questions down beforehand, including what each option would mean day to day. Ask how kidney function, tiredness and side effects are monitored during treatment. Keeping active within your limits, eating well and staying hydrated support kidney function and help you tolerate treatment.