PAYING IT FORWARD / KCWs Chain of Love:

kidney cancer patients & their loved ones sharing personal journeys & information obtained along the way via this blog and our chat room to support one another and help bring awareness to this lessor known cancer.

Paying it Forward by providing support to those who will unfortunately follow our paths while also honoring those who are no longer with us.

KCWs Chain of Love: Reaching forward with one hand to those who paved the path before us, reaching behind us with the other hand to those who will unfortunately follow our journey.

Meds/SEs/Remedies

Recommended Remedies For Specific Side Effects

Side Effects for each of these drugs will vary from person to person.  The most important thing to remember is that just as no two people are alike, no two people will respond to a medication in regards to side effects or effectivenss in exactly the same way.  This is very important that you keep this in mind.  Along your journey, you may hear someone tell you to expect on the 3rd week, you will get mouth sores.  Please don't listen to that aspect of the story.  Yes, that person got mouth sores on the 3rd week, it does not mean YOU will get mouth sores on the 3rd week.  You may not get them at all or you may get them sooner or later, they may last longer for you or last only a short amount of time.  Each experience is different for each patient.  The important part of listening to the journey shared by someone who has been on the med you are about to start is so that you have some idea what to expect.  There is no way you will know exactly what your experience will be on a daily basis.  Again, I will say, each patient resonds differently.  You may be very fortunate and experience none of the side effects, you may experience all of the side effects or you may experience just a few of the side effects.   Also, severity of side effects are measured depending on grades - with Grade 1 being the lowest severity to Grade 5 being the worst severity and the most concerning.  Another very important thing to understand - having side effects or severe side effects verses having no side effects does not correlate with the effectiveness of the drug.  You may be hearing things to the opposite of this statement.  I assure you just by the experiences of individuals in our chat room.  Having had one person on Afinitor with absolutely no side effects and receiving absolutely no benefit, having had another person on Afinitor with absolutely no side effects and receiving excellent benefits now for two years almost.  My husband has been on HD-IL2, Sutent, Nexavar, Afinitor, Sutent again, and now Votrient.  He has had all the worst possible side effects with all these medications except with Votrient.  Votrient has been kind to him regarding side effects.  Does that mean Votrient is the medication that isn't working for him?  Actually, no, it doesn't.  Votrient is working for him and Sutent (which he had horrible side effects has worked for him).  All the other treatments did not work for him.  So that should prove the theory having side effects = the med is working and having no side effects = the med is ineffective to be inaccurate

Be sure to keep your physician fully aware of all side effects and their severity.  There may be times they need to put your med on hold or decrease your med or both.  Other times they will come to the conclusion your treatment plan needs to change due solely on the severity of your side effects.  Do not let this discourage you.


Information Provided To You As Recommended By Other Kidney Cancer Warriors Regarding The Following Side Effects:

(Please keep in mind, what works for one person, may not work for the next and ALWAYS check with your medical team before adding anything new.)

HFS - Hand Foot Syndrome

Most of us had not heard of this syndrome before being diagnosed or having a loved one be diagnosed with kidney cancer. So before giving the remedies, first is an explaination of HFS - the symptoms that are part of HFS are as follows:

  • numbness, tingling or the feeling of "pins and needles" or "walking on glass"
  • sensitivity to hot objects
  • pain or tenderness
  • burning sensation
  • swelling
  • buildup of hard skin or calluses at pressure points
  • blistering
  • dry and/or cracked skin
  • peeling and/or flaking skin
(Please note: the HFS presents differently with different patients.  It usually occurs on the hands and feet thus the name of the syndrome; however, it can also occur on your elbows, knees, etc.)

Suggestions recommended to prevent or help ease some of the discomfort with HFS:

  • avoid friction -
  • avoid activities which cause friction on your feet like jogging, aerobics, long walks
  • avoid activities that involve friction on the hands such as use of tools or utensils that involve pressing your hand against a hard surface (gardening tools, knives, screwdrivers, shovel, etc)
  • avoid heat to your hands and feet -
  • avoid hot water when washing dishes or bathing
  • do not use rubber gloves with hot watter (the rubber can trap the heat against your skin)
  • avoid exposure to heat, including saunas, sunbathing, sitting in front of sunny windom

Suggested remedies:

  • intensive creams and moisturizers (Udderly Smooth, Revita-Derma 40%, Eucerin, Kerasal, Aveeno, Lubiderm, Aquaphor, Curel, baby oil... (the higher the percentage of urea, the better. Also, oils are good!)
  • apply ice pack or cool compress indirectly to your hands and feet for 15 to 20 minutes (you can alternate 15 to 20 minutes on your hands and feet with 20 minute breaks between)

  • Elevating your hands and feet when sitting or lying
  • when drying after a shower, pat your skin dry, avoid rubbing your skin with a towel
  • wear loose, well-ventilated shoes and clothing (New Balance is a highly recommended shoe by podiatrist and fellow warriors)
  • wear cotton socks (Thermo socks are highly recommended by fellow warriors)
  • gel inserts
  • don't wear the same pair of socks or shoes for longer than 4 hours
  • soaking affected skin in a mix of epsom salts and warm water (not hot)
RASH / ITCHING
  • Use anti-dandruf shampoo on scalp and as body wash

  • Aveeno Oatmeal bath
  • wear loose-fitting clothing
  • use mild soaps/body wash with no perfumes
  • avoid hot showers/baths
  • avoid direct sun exposure
  • use sunblock with 30SPF or higher (sunblock should include titanium dioxide or zinc oxide)
  • wear a broad-brimmed hat when exposed to the sun
  • Moisturize your skin after showering
  • apply gently without friction, do not rub
  • Do not use moisturizers or creams with perfumes or preservatives
  • Recommended products for dry skin....from other warriors: Udderly Smooth, Eucerin, Aveeno, Lubiderm, Aquaphor, Curel, baby oil...if also itching, you can try benadryl lotion or Corticosteroid cream; also for itchy skin, take benadryl 25mg to 50mg as directed on box. Again, check with your medical team first.
Info about Moisturizer ingredients:

On the most basic level, moisturizers hold water in the outermost layer of skin. They also act as a temporary barrier. Many moisturizers contain some combination of humectants and emollients, as well as other ingredients.

Dry skin. To restore moisture to dry skin, choose a heavier, oil-based moisturizer that contains urea or propylene glycol — chemicals that help keep your skin moist. For very dry, cracked skin, oils are preferable. They have more staying power than creams do and are more effective at preventing water from evaporating from your skin.

Humectants (urea, glycerin, alpha hydroxy acids, others). These are substances that absorb water from the air and hold the moisture in the skin. Humectants need very high humidity levels to be effective. Humectants are also useful in softening thickened or scaly skin.

Emollients (lanolin, mineral oil, petrolatum, others). These ingredients fill in the spaces between the cells in the skin, helping replace lipids and thus smoothing and lubricating rough skin. Emollients are either oil based, which means that a small amount of water is dissolved in oil, or water based, which means they are primarily water and have a light, nongreasy feel. Oil-based creams leave a slight residue on the skin and have more staying power than water-based creams do. Water-based creams are easier to apply and don't leave much of a residue, but they don't have as much staying power. Most creams and lotions on the market are water based (for example, Vanicream and Cetaphil). Eucerin is an example of an oil-based cream.

Fragrances. Most moisturizers include fragrances, which give the product a fresh, pleasing odor and cover up the smell of other ingredients. Fragrances in skin-care products are the most likely cause of skin irritations or contact allergies.

Preservatives. Any product that includes water and oil must contain one or more preservatives to help prevent bacterial contamination after the product is opened. Most products contain multiple preservatives. These ingredients can sometimes cause skin allergies or reactions.

Moisturizers may include other ingredients as well, such as vitamins, minerals, plant extracts, sunscreens and sunless tanners. Some also contain ingredients that claim to boost your body's production of collagen and elastin, diminish stretch marks, smooth out wrinkles, paralyze muscles, unblock pores, and exfoliate dead skin cells. Many of these claims are unproved.

Keep in mind that there's no guarantee that any moisturizer will live up to all of its claims or even contain its advertised ingredients. Moisturizers are considered cosmetics, so the Food and Drug Administration (FDA) regulates them in a different and more lenient manner than it does drugs. This means that products don't need to undergo the same rigorous testing for safety and effectiveness before going to market that prescription drugs do.


Diarrhea

It is important to treat diarrhea to avoid dehydration and weight loss.

  • Eat only mild foods
  • Drink plenty of water or clear liquids daily but only in small sips
  • Eat several small meals a day
  • Avoid hot and cold liquids
  • Drink at least 1 glass of liquid after each loose bowel movement
  • Take standard anti-diarrhea meds as prescribed by your doctor such as immodium - possibly even preventively - as in one in am and one in pm while on medication causing diarrhea (again, always check with your medical team first.)
Avoid: 

  • dairy products, high fat foods, high fiber foods
  • gas forming and spicy foods
  • alcohol, caffeine, prune and orange juices
  • sugar-free candy or gum with sorbitol
  • fruit

Constipation:
  • Avoid spicy foods, fatty foods, caffeine, and fruit
  • Eat only mild foods
  • Drink water often—but only in small sips

  • Managing diarrhea or bowel movement changes. These symptoms may be treated with over-the-counter medicines. Ask your doctor or nurse which product may be best for you.
  • Managing nausea or vomiting. If you have these problems, tell your doctor or nurse. He or she may prescribe a medicine for these symptoms.
  • A high-fiber diet. A diet with at least 20 to 35 grams of fiber each day helps your body form soft, bulky stool. High-fiber foods include beans, whole grains and fresh fruits and vegetables. Limit foods that have little to no fiber, such as cheese, meat and processed foods.
  • Regular exercise. Physical activity will help stimulate intestinal activity.
  • Adequate fluid intake. Drinking plenty of water and other fluids will help soften your stool.
  • Take the time for bowel movements. Set aside sufficient time to allow for undisturbed visits to the toilet. And don't ignore the urge to have a bowel movement.
  • Laxatives. These over-the-counter medications should be considered as a last resort because they can become habit-forming. There are several different types of laxatives:

  • Stimulants cause rhythmic contractions in the intestines. Examples include Correctol, Dulcolax and Senokot.

  • Lubricants enable stool to move through your colon more easily. Examples include mineral oil and Fleet.

  • Stool softeners moisten the stool and help prevent dehydration. Examples include Colace and Surfak.
  • Fiber supplements, or bulk laxatives, are generally considered the safest of laxatives. Examples include FiberCon, Metamucil, Konsyl, Serutan and Citrucel. These agents must be taken with plenty of water.
  • Osmotics help fluids to move through the colon. Examples include Cephulac, Sorbitol and Miralax.

  • Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Examples include milk of magnesia & Haley's M-O.

  • Chloride channel activators. The agent lubiprostone (Amitiza) is available by prescription and increases fluid content of stool.

  • 5-HT-4 agonists. These agents stimulate release of compounds in your body that increase fluid secretion in the intestines and decrease colonic transit time. Prucalopride is one such 5-HT-4 agonist.

Fatigue:

Some sources of fatigue are treatable such as medication interactions, pain, emotional distress, sleep disturbances, anemia, and diet

  • set priorities so can finish your most important tasks

  • save demanding activities for when you have the most energy
  • avoid long naps during the day
  • distract yourself with games, music, books, etc
  • stay as active as you can during the day
  • exercise regularly (after approval from doctor)
  • If you feel tired or weak, these tips may help:
  • Take short naps or breaks
  • Eat well and drink plenty of fluids
  • Take short walks or do light exercise
  • Do things that are relaxing, such as listening to music or reading
Mouth Sores -

  • Keep a clean and healthy mouth by brushing gently and flossing often (if possible, there may be times flossing may have to be forgone) 
  • rinse mouth out frequently with water
  • brush teeth gently with biotene toothpaste or other gentle toothpaste
  • rinse mouth with:
  • biotene mouthwash
  • aloe vera gel use as mouth wash (highly recommended - can be obtained at your local health food store - ensure you get aloe that can be taken orally not topically. You can get it with 99.3% aloe or you can get it diluted. Best to get the higher percentage. If you can't tolerate it, dilute it with water. Also, it can be swallowed and will help your digestive system as well. It is considered a "dietary supplement.")
  • miracle mouthwash - this is prescribed by your physician. They can write the order with or without the "numbing" ingredient (most patients do not like the "numbing" effect.

  • If you have stomatitis, these tips may help:
  • Avoid hot, spicy, or acidic foods
  • Eat foods that are soft
  • Use a straw for drinking liquids
  • Use an alcohol-free mouthwash, and rinse your mouth often with water
  • Avoid toothpastes with whiteners (ie, peroxide)
Taste Changes -

  • loss of taste entirely or bad taste
  • rinse mouth out frequently with water
  • Cold or frozen foods may taste better than hot foods
  • Flavor your food with herbs, spices, sugar, lemon, or sauces
Metalic taste

  • rinse mouth out frequently with water
  • Loss of appetite
  • remember, eating is important. Keeping up your nutritional strength is part of your body's ability to fight against the cancer.
  • eat small, frequent meals
  • let someone else cook for you
  • eat when you are hungry
  • eat when food is cold so the odor is eliminated
  • Flavor your food with herbs, spices, sugar, lemon, or sauces
Nausea/Vomiting

  • take anti-emetic medications (such as phenergan, zofran)
  • have someone cook for you
  • eat when food is not hot to eliminate odor
  • eat foods you like
  • Eat small meals
  • Avoid foods that are sweet, fried, or fatty
  • Drink lots of fluids, but in small amounts
Upset Stomach

  • Avoid heavy meals, coffee, and alcohol
  • Reduce your stress
  • Sleep in a more upright position, propped up on a pillow
  • Take an antacid
  • Eat small meals
  • Avoid foods that are sweet, fried, or fatty
  • Drink lots of fluids, but in small amounts
Reflux

  • There are great medictions you can take. Some are over-the-counter like prilosec (omeprazole). Others you need a prescription like Nexium (the best according to most pharmacist).
  • Don't eat 3-4 hours before going to bed
  • Elevate head of bed (you can use bricks or books)
  • Avoid spicy food
  • Avoid pizza, lasagna, spaghetti, etc (tomatos tend to cause reflux)
Abdominal Pain


HAIR LOSS (Scalp and body)

  • the best thing you can do is wash and comb hair gently and not often.
  • don't play with your hair often
  • do like recommend by one of the KCW's in her story, go buy some wigs and decide you're going to look fabulous in them

HAIR CHANGES (Color And Texture)

  • No recommendations found
  • My personal belief is this is one of those s/e's you just have to live with unless you want to try coloring your hair for the color change; for the texture - Allen's hair got fried while taking Afinitor, we just conditioned it frequently and it helped.
Skin Color Changes
(usually yellowish or orangish)

  • No recommendations found

Swelling

Call your doctor if you have any swelling or bleeding.

Bleeding from nose or cuts

Call your doctor if you have any swelling or bleeding.


The End of Remedy Recommendations for Side Effects
-------------------------------------------------------------------------------------------
Part II:  FDA Approved Medications To Treat Renal Cell Carcinoma

RCC is the most common malignancy of the kidney and is highly resistant to chemotherapy,” said Paolo Paoletti, MD, Senior Vice President, GlaxoSmithKline Oncology R&D Unit. “While treatment has improved in the past few years with the introduction of targeted therapies, advanced RCC remains a challenging disease.”


Information about Drugs:There are 2 types of drugs for RCC that affect tumor cell growth. One is called a vascular endothelial growth factor–specific angiogenesis inhibitor (VEG-F) and the other is a mammalian target of rapamycin (mTOR) inhibitor.




Multi-kinase inhibitors


There are drugs called multi-kinase inhibitors used to treat RCC that has spread. Patients can take some of these drugs orally (by mouth). Multi-kinase inhibitors are anticancer drugs that are not chemotherapies. These drugs may slow or stop some cancers. They block 2 basic processes that cause tumors to grow and spread. One of these drugs is

Sutent (sunitinib malate)
VEGF; FDA approved in 2006
Currently the first line of treatment


Sutent works by blocking 2 basic processes that cause tumors to grow and spread - proliferation (cell divides) and angiogenesis (new blood vessels form which give the tumor the nutrients and oxygen it needs to grow.)




SUTENT may interact with other treatments or products. Tell your doctor or nurse about each medicine, vitamin, or herbal product that you use. Do not take St. John's Wort, eat grapefruit, or drink grapefruit juice while taking SUTENT (it has also been suggested by some physicians not to eat oranges or take Vitamin C - please check with your medical team before taking any vitamins.)


Side effects:
  • Fatigue
  • Rash
  • Itching
  • Hair loss (Scalp and body) / Some pts have reported hair thickening
  • Hair Changes in Color (usually white) and texture
  • Skin changes - color usually a yellowish or orangish
  • Mouth Sores
  • taste changes - loss of taste entirely or bad taste
  • Metalic taste
  • loss of appetite
  • upset stomach
  • abdominal pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • HFS (Hand Foot Syndrome)
  • swelling
  • bleeding from nose or cuts
  • thyroid issues
  • foul flatulance (as reported by many warriors)


Call your doctor if you have swelling or bleeding


More severe side effects or adverse effects:
  • Hypertension (High blood pressure)
  • Heart problems - if you feel tired, short of breath, feel faint or dizzy, or have swollen feet and ankles, inform your doctor
While on sutent be sure:
  • Your blood pressure is being monitored.  If you were already on blood pressure medications before starting sutent, you may need your blood pressured medications increased at some point while taking sutent.  Also, if you were not taking blood pressure medications before starting sutent, you may need to be placed on blood pressure medications.
  • Your heart is being checked on a regular basis.  Some patients have echocardiograms and others have MUGA scans.  Some patients will have an echocardiogram and if there is anything out of the ordinary, a MUGA scan will be ordered.  MUGA scans reveal more information about the heart's function.  It depends on your physician.  However, if you are on sutent and you've not been getting an echocardiogram or a MUGA scan, you should remind your physician that your heart needs to be followed while on sutent.
  • Your TSH, T4 is checked with your lab values.  This checks the function of your thyroid.  Sutent often causes ones thyroid to not work properly causing hypothyroidism.  Hypothyroidism is easily treated with medication like synthroid.
Please scroll up to see remedies suggested by your fellow kidney cancer warriors and / or their loved ones!

Nexavar(sorafenib tosylate)
VEGF; FDA approved 2005


Side Effects:
  • Rash, redness, itching, or peeling of your skin
  • Hair thinning or patchy hair loss
  • Diarrhea
  • Nausea
  • Vomiting
  • Mouth Sores
  • Loss of appetite
  • Abdominal pain
  • Weight Loss
  • Numbness, tingling, or pain in hands and feet
  • HFS (Hand Foot Syndrome)
  • Weakness
  • Fatigue
More serious side effects:
  • Hypertension
  • HFS 
  • Decreased blood flow to the heart / heart attack
  • Bleeding Problems
  • Perforated Bowel
  • Wound Healing Problems
Afinitor(everolimous)
 mTOR inhibitor;FDA approved March 2009




SideEffects:
  • oral ulcerations (topical treatments are recommended, but alcohol- or peroxide-containing mouthwashes should be avoided. Antifungal agents should not be used unless fungal infection has been diagnosed.)
  • stomatitis
  • infections
  • asthenia
  • fatigue
  • cough 
  • diarrhea 
  • dyspnea 
  • dehydration 
  • abdominal pain
  • elevated serum creatine
  • hyperglycemia (elevated glucose/sugar)
  • elevated lipids
  • hypertriglyceridemia (elevated tryglycerides)
  • reduced lymphocytes, neutrophils and platelets
  • anemia
  • lymphopenia
  • increased creatinine
  • hypophosphatemia
  • hypercholesterolemia
Severe or Adverse Effects:
  • Non-infectious pneumonitis (4%) - moderate or severe, patients should be managed with dose interruption until symptoms improve or discontinuation, respectively. Corticosteroids may be indicated. Afinitor may be reintroduced at 5 mg daily depending on the individual clinical circumstances.
  • Afinitor has immunosuppressive properties and may predispose patients to infections. Localized and systemic infections (bacterial and invasive fungal infections) have occurred. Some of these infections have been severe or fatal. Complete treatment of pre-existing invasive fungal infections prior to starting treatment. If a diagnosis of invasive systemic fungal infection is made, discontinue Afinitor and treat with appropriate antifungal therapy.
Votrient 
Another Site for Votrient
And Another Site for Votrient (Because It Is a New Drug)


kinase inhibitor; FDA approved 2009


Side Effects:


More common:
  • Abdominal or stomach pain or tenderness
  • Black, tarry stools
  • Bleeding gums
  • Blood in the urine or stools
  • Blurred vision
  • Chest pain
  • Chills
  • Clay colored stools
  • Cloudy urine
  • Constipation
  • Cough
  • Coughing up blood
  • Dark urine
  • Decreased or loss of appetite
  • Depressed mood
  • Difficulty with breathing or swallowing
  • Dizziness
  • Dry skin and hair
  • Feeling cold
  • Feeling tired
  • Fever
  • Hair loss
  • Headache
  • Hoarseness or husky voice
  • Increased menstrual flow or vaginal bleeding
  • Itching
  • Lower back or side pain
  • Muscle cramps and stiffness
  • Nausea and vomiting
  • Nervousness
  • Nosebleeds
  • Painful or difficult urination
  • Pale skin
  • Paralysis
  • Pinpoint red spots on the skin
  • Pounding in the ears
  • Prolonged bleeding from cuts
  • Red or black, tarry stools
  • Red or dark brown urine
  • Redness, swelling, or pain of the skin
  • Scaling of the skin on the hands and feet
  • Shortness of breath
  • Skin rash
  • Slow or fast heartbeat
  • Sore throat
  • Sores, ulcers, or white spots on the lips or in the mouth
  • Swelling of the feet or lower legs
  • Swollen glands
  • Tingling of the hands and feet
  • Ulceration of the skin
  • Unusual bleeding or bruising
  • Unusual tiredness or weakness
  • Weight gain
  • Yellow eyes or skin
Less common:
  • Bleeding from rectum or bloody stools
  • Blood in the urine
  • Bloody nose
  • Chest pain or discomfort
  • Confusion
  • Coughing or spitting up blood
  • Fainting
  • Irregular heartbeat
  • Irregular or slow heart rate
  • Numbness or tingling in the face, arms, or legs
  • Pain or discomfort in the shoulders, arms, jaw, back, or neck
  • Sweating
  • Swelling or puffiness of the face
  • Trouble speaking, thinking, or walking
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:


More common:
  • Change in hair color
  • Change in taste
  • Decreased weight
  • Diarrhea
  • Hair loss
  • Lack or loss of strength
  • Loss of taste
  • Thinning of the hair
  • Weight loss
Less common:
  • Acid or sour stomach
  • Belching
  • Heartburn
  • Indigestion
  • Stomach discomfort, upset, or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.




Tell your healthcare provider right away if you have any of these signs of liver problems:
  • yellowing of your skin or the whites of your eyes (jaundice)
  • dark urine
  • tiredness
  • nausea
  • vomiting
  • loss of appetite
  • pain on the right
Call your health care provider right away, if you have any of the following symptoms:
  • high blood pressure
  • irregular or fast heartbat or fainting
  • heart attack or stroke: chest pain or pressure, pain in your arms, back, neck or jaw, shortness of breath, numbness or weakness on one side of your body, trouble talking, headache, or dizziness.
  • bleeding problems: unusual bleeding, bruising, wounds that do not heal.
  • tear in your stomach or intestinal wall (perforation) or bleeding: pain, swelling in your stomach-area, vomiting blood, and black sticky stools.
  • thyroid problems




TORISEL
mTOR inhibitor;  approved ?


The most common side effects:
  • Rash
  • Weakness/fatigue
  • Mouth sores
  • Nausea
  • Swelling/fluid retention
  • Loss of appetite
  • Elevated levels in Blood Glucose
  • Elevated Triglycerides
  • Elevated cholesterol
  • Increased Risk of Infection
Before you begin treatment with Torisel, your doctor may give you an antihistamine. It is possible to have a seirous allergic reaction even after your receive an antihistamine. Tell your doctor or nurse if you are allergic to antihistamines or are unable to take them for nay other medical reasons. Tell your doctor or nurse if you have any swlling around your face or difficulty breathing during or after treatment.

Avastin
VEG-F; FDA approved August 2009
 Side Effects:
  • nosebleeds
  • headache
  • high blood pressure
  • inflammation of the nose
  • too much protein in the urine
  • taste change
  • dry skin
  • rectal bleeding
  • tear production disorder
  • back pain
  • inflammation of the skin (exfoliative dermatitis)
  • tiredness
  • weakness
  • too much protein in the urine
  • high blood pressure 
More serious side effects / adverse effects:


  • Bowel perforation. Tell your doctor right away if you have any new or worsening stomach pain or blood in your stool. Rare fatal occurences have been reported.

  • Wounds will not heal properly. If surgery is required while on this medication, you will need to discuss with your doctor. The medication will need to be stopped.

  • Chronic inflammation of the lungs. If you have any trouble breathing, get a cough, or develop a fever, tell your doctor right away.

  • Risk of kidney failure

  • Risk of bleeding in the brain. Increased risk if you have a brain tumor or you are taking medicine to keep your blood from clotting.

  • Some vaccines may be less effective while on torisel. You should avoid the use of live vaccines and close contact with people who have recently received live vaccines. Ask your doctor or nurse if you are elegible to receive a flu shot

Serious Side Effects / Adverse Effects:



  • Gastrointestinal (GI) perforation: Treatment with Avastin can result in the development of a potentially serious side effect called GI perforation, which is the development of a hole in the stomach, small intestine, or large intestine. In clinical trials, this event occurred in more people who received Avastin than in the comparison group (0.3% to 2.4%). In some cases, GI perforation resulted in fatality. Avastin therapy should be permanently stopped if GI perforation occurs.
  • Surgery and wound healing problems: Treatment with Avastin can lead to slow or incomplete wound healing (for example, when a surgical incision has trouble healing or staying closed). In some cases, this event resulted in fatality. Surgery and wound healing problems occurred more often in people who received Avastin than in the comparison group. Avastin therapy should not be started for at least 28 days after surgery and until the surgical wound is fully healed. The length of time between stopping Avastin and having voluntary surgery without the risk of having surgery and wound healing problems has not been determined. Treatment with Avastin should be stopped at least 28 days before voluntary surgery and in people with surgery and wound healing problems that require medical treatment.
  • Severe bleeding: Treatment with Avastin can result in serious bleeding, including coughing up blood, bleeding in the stomach, vomiting of blood, bleeding in the brain, nosebleeds, and vaginal bleeding. These events occurred up to 5 times more often in people who received Avastin. Across cancer types, 1.2% to 4.6% of people who received Avastin experienced severe to fatal bleeding. People who have recently coughed up blood (greater than or equal to a half teaspoon of red blood) or have serious bleeding should not receive Avastin. Treatment with Avastin should be permanently stopped if serious bleeding occurs (ie, requiring medical attention).
  • The formation of an abnormal passage from parts of the body to another part (non-GI fistula formation) was seen in 0.3% or less of people.
  • Severe to life-threatening stroke or heart problems were seen in 2.4% of people.
  • nervous system and visual disturbances (reversible posterior leukoencephalopathy syndrome), which was seen in less than 0.1% of people.
  • Infusion reactions with the first dose of Avastin were uncommon and occurred in less than 3% of people, and severe reactions occurred in 0.2% of people.
There are 2 different cytokines for RCC:
How do cytokines work?

Cytokines stimulate the immune system. Then the immune system can attack cancer cells the way that it attacks an infection. These drugs are given under the skin, into muscle, or into a vein. This is most often done in a hospital or clinic
Interferon














HD-IL2 (High Dose Interlukin 2)
Interlukin 2
FDA approved 1992