Immunotherapy after surgery for kidney cancer

You might have an immunotherapy drug if you have had surgery to remove the kidney cancer but there is a high chance of it coming back.

This page is about immunotherapy for kidney cancer that has been treated with surgery. You may also have immunotherapy for kidney cancer that has spread or come back (advanced kidney cancer).

What are immunotherapy drugs?

Immunotherapy uses our immune system to fight cancer. It works by helping the immune system to recognise and attack cancer cells. Immunotherapy drugs can work in different ways.

When you might have immunotherapy for kidney cancer

Surgery is the main treatment for kidney cancer that has not spread to other parts of the body. Your surgeon may remove your whole kidney (radical nephrectomy). Or they remove only the part of your kidney where the cancer is (partial nephrectomy).

If the kidney cancer has spread to another part of the body (secondary or metastatic cancer), your surgeon may still be able to remove all the cancer. But as it has already spread, there is an increased risk of it coming back.

After your operation, a specialist doctor (pathologist) looks at the cancer under a microscope. They decide what grade the cancer is. The grade give your doctor an idea of how the cancer might behave. For example, a high grade cancer is more likely to come back than a low grade cancer.

Other factors that affect the chance of the cancer coming back include:

• the type of kidney cancer
• the size of the cancer in the kidney
• if cancer cells are found in nearby lymph nodes

If you have an increased risk of the cancer coming back after surgery, your doctor may recommend you have an immunotherapy drug. This is called adjuvant treatment. It helps to reduce the chance of the cancer coming back.

Pembrolizumab (Keytruda) for kidney cancer

Pembrolizumab (pronounced pem-bro-lee-zoo-mab) is an immunotherapy drug. It is also known by its brand name, Keytruda.

It targets and blocks a protein called PD-1 on the surface of certain immune cells called T cells. Blocking PD-1 allows T cells to find and kill the cancer cells. This is called a checkpoint inhibitor.

Having pembrolizumab

You have pembrolizumab through a drip into your bloodstream every 3 to 6 weeks. You may have this in a small tube in your vein (cannula). Or you might have it in a long plastic tube that goes into a large vein in your chest, such as a central line or PICC line.

Side effects

Everyone is different and side effects vary from person to person.

Some of the side effects with immunotherapy can be serious and may not go away. Your doctor or nurse will talk to you about these and what to look out for during treatment. A side effect may get better or worse during the course of your treatment. Or more side effects may develop as the treatment goes on. With immunotherapy, side effects can even start after you've finished the treatment.

Always tell your doctor or nurse about any side effects you have and follow their advice.

Research into immunotherapy for kidney cancer at higher risk of coming back

Researchers continue to look at ways of reducing the risk of kidney cancer coming back, including immunotherapy. They are looking at:

• new immunotherapy drugs

• having immunotherapy or targeted cancer drugs before surgery

• new drugs in combination with immunotherapy

How you may feel

It can be frightening to know there is a higher chance of the cancer coming back.  You can talk this through with your doctor or specialist nurse. They can:

• reassure you
• explain how often you will have checks
• refer you to support groups