Kidney cancer

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Treatments for stage 4 kidney cancer

The following are treatment options for stage 4 kidney cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Targeted therapy


Your healthcare team will consider many disease-related and prognostic factors (predictors of survival) to help them decide which targeted therapy would be the most effective for you. These factors include the type of kidney cancer and any other treatments you’ve already had, as well as the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) classification.


  • sunitinib (Sutent)
  • pazopanib (Votrient)
  • sorafenib (Nexavar)
  • axitinib (Inlyta)

Sunitinib is usually the first drug to be used because it has been shown to be the most effective. It can also be combined with gemcitabine (Gemzar), a chemotherapy drug, for kidney cancers that aren’t a clear cell type or for kidney cancer with poor prognostic factors.

Mammalian target of rapamycin (mTOR) is a protein that helps cells grow and divide. Targeted therapy drugs that work on mTOR to treat stage 4 kidney cancer include:

  • temsirolimus (Torisel)
  • everolimus (Afinitor)

Tyrosine kinase is a protein on the surface of cells that sends signals to help cells grow and form new blood vessels. A targeted therapy drug that works on tyrosine kinase (called a tyrosine kinase inhibitor) to treat stage 4 kidney cancer is lenvatinib (Lenvima). It may be used in combination with everolimus if you have been given VEGF targeted therapy before. Lenvatinib may not be covered by all provincial health plans.





Immunotherapy helps to strengthen or restore the immune system’s ability to find and destroy cancer cells. It is not usually used in Canada because targeted therapies are better at treating kidney cancer.

Immunotherapy may be used in specialized centres to treat people who have kidney cancer, either as a main treatment in certain cases or for kidney cancer that no longer responds to targeted therapy. Your healthcare team may recommend immunotherapy as a good treatment option for you. Immunotherapy drugs used to treat stage 4 kidney cancer includes:

  • Pembrolizumab (Keytruda) may be used treat advanced or metastatic kidney cancer that hasn’t been treated with systemic therapy. It is given along with the targeted therapy drug axitinib.

Arterial embolization

Arterial embolization blocks the blood supply to a kidney tumour. It can help shrink the tumour, control bleeding in the kidney and relieve symptoms such as pain. You may be offered arterial embolization if you aren’t well enough to have targeted therapy or surgery.

Ablation therapy


Radiation therapy


If kidney cancer spreads to the bones or brain, radiation therapy is often used to treat it. Find out more about bone metastasis and brain metastasis.

Active surveillance


If you can’t have or don’t want cancer treatment



Clinical trials


prognostic factor

A situation or condition, or a characteristic of a person, that is considered when making a prognosis.

There are many different prognostic factors, including the type and stage of the cancer and the person’s age and overall health.

systemic therapy



Also called systemic treatment.


