Kidney cancer that has spread is also called advanced or metastatic kidney cancer. Once cancer has spread to other organs in the body, it usually cannot be cured. However, there are several treatments that can be used to keep the cancer under control, sometimes for many years.

Different specialists, such as medical oncologists, urologists and medical radiologists, may recommend combinations of different treatments. A team of specialists will work with you and your GP to help control your symptoms and help you to live as normal a life as possible for as long as possible. Treatments for advanced kidney cancer include:

• Surgery – often the first treatment for advanced kidney cancer. Although surgery cannot cure kidney cancer that has spread, surgery may be recommended to reduce symptoms, especially pain and discomfort. This is called debulking surgery or cytoreductive surgery.
• Targeted therapies – drugs that target specific biological signals in the cancer cells to stop cell growth and the development of a new blood supply to the tumour (angiogenesis). Treatments that interfere with the development of a blood supply are called anti-angiogenic. Targeted therapies used for the treatment of advanced kidney cancer are called vascular endothelial growth factor (VEGF) inhibitors (sometimes called tyrosine kinase inhibitors, TKIs), such as sunitinib, pazopanib, axitinib, cabozantinib, and lenvatinib. There are also mammalian target of rapamycin (mTOR) inhibitors, such as everolimus and temsirolimus. These anti-cancer medicines are tablets that are taken orally. They are sometimes called systemic therapies because they travel in the blood to reach the cancer cells.
• Immunotherapies – drugs that boost the body’s immune system to destroy cancer cells. Immunotherapies used for the treatment of advanced kidney cancer are called immune checkpoint inhibitors, such as nivolumab, pembrolizumab, ipilimumab and avelumab. Immune checkpoint inhibitors are also sometimes named after checkpoint proteins – for example, CTLA-4 inhibitors, PD-1 inhibitors and PD-L1 inhibitors. Immunotherapies are given by infusion into a vein in the arm every 2-4 weeks. Usually, immunotherapy is given in hospital. Immunotherapy is a systemic therapy because it travels in the blood to stimulate the immune cells.
• Combination therapy – the treatment of patients with two or more cancer medicines at the same time (in combination), for example nivolumab plus ipilimumab, pembrolizumab plus axitinib, pembrolizumab plus lenvatinib, nivolumab plus cabozantinib, and avelumab plus axitinib. The aim of combination therapy is to treat patients with medicines that work in different ways to reduce resistance of the cancer to treatment and improve survival. Each medicine is used at the most effective and tolerable dose. By using medicines that work in different ways to attack the cancer cells, combination therapies offer a two-pronged approach to treating kidney cancer, giving people longer survival times while maintaining their quality of life.
• Radiotherapy – although kidney cancer cells are not very sensitive to radiation, conventional radiotherapy can still be used to help control the symptoms of advanced kidney cancer, particularly neuropathic pain. Stereotactic radiotherapy (SRT) (also called stereotactic radiosurgery (SRS) or gamma knife surgery or CyberKnife®) can be used to treat small numbers of metastases in the brain. This uses high doses of radiation directed at the cancer using a head frame. Only a single treatment may be needed. Stereotactic body radiotherapy (SBRT) can be used to treat metastases found in the liver, lung and pancreas, as well as the brain. In SBRT, radiotherapy is focused at the area of the body containing the tumour to kill the cancer cells and avoid damaging as much healthy tissue as possible.
• Supportive/palliative care – includes all the treatments that your medical team recommends to improve your symptoms (especially pain) and your quality of life. You can receive supportive/palliative care from when you are diagnosed with cancer and throughout your treatment. Supportive/palliative care also includes looking after your spiritual, social and psychological wellbeing.

Please see Kidney cancer medicines on our website for a list of currently available medications for RCC in the UK.

Cancer Research UK: Kidney cancer

Cancer Research UK: Stereotactic radiotherapy

Macmillan: Kidney cancer

NHS: Kidney cancer

European Association of Urology (EAU) Renal Cell Carcinoma guidelines: 7. Disease management

Further reading: Action Kidney Cancer Essential guide: Treatment for advanced renal cell carcinoma (RCC)

Updated: October 2023                                                                                                                      Next review: October 2025