Kidney cancer is often found by chance, on a scan done for another reason. The most common type is clear cell renal cell carcinoma, and smoking, excess weight and high blood pressure all raise the risk. Treatment has changed dramatically, first with drugs that block the tumor’s blood supply, then with immunotherapy, and now with a new kind of pill. This article explains how kidney cancer grows, the tests every patient needs, the 2026 results for treatment after surgery, the options for advanced disease, and how to protect the remaining kidney.
How Kidney Cancer Grows
In most clear cell kidney cancers, a gene called VHL has been lost. Without it, the cancer cells behave as though they are starved of oxygen, and a switch called HIF-2α stays turned on. That switch drives the growth of new blood vessels to feed the tumor. This is why drugs that block blood vessel growth, such as sunitinib, axitinib, cabozantinib and lenvatinib, work in kidney cancer, and why belzutifan, which blocks HIF-2α itself, is so important.
The Tests Every Patient Needs
A CT or MRI scan shows the size and spread of the tumor, and a biopsy or the removed tumor confirms the type, because clear cell, papillary and other kidney cancers are treated differently. For advanced disease, a simple risk score based on blood tests and how quickly the cancer appeared helps choose treatment. People diagnosed young, or with tumors in both kidneys, should have genetic testing for inherited conditions such as von Hippel-Lindau disease. See our article on tumor DNA and RNA sequencing.
Surgery, and Treatment After It
Whenever possible, surgeons remove only the tumor and save the rest of the kidney, called a partial nephrectomy, to protect kidney function.
Immunotherapy after surgery. For people at higher risk of the cancer returning, a year of pembrolizumab after surgery reduced the risk of death by 38 percent in the KEYNOTE-564 trial, the first treatment after kidney cancer surgery shown to extend survival.1
2026: adding belzutifan. In the LITESPARK-022 trial of 1,841 patients, published in the New England Journal of Medicine in July 2026, adding belzutifan to pembrolizumab after surgery reduced the risk of the cancer returning by 28 percent compared with pembrolizumab alone. It is too early to know whether it extends survival. Serious side effects were more common, 52 percent compared with 30 percent, mainly anemia and low oxygen levels, which belzutifan is known to cause.2
Advanced Kidney Cancer
Immunotherapy combinations. First treatment today usually combines two immunotherapy drugs, nivolumab with ipilimumab, or an immunotherapy drug with a blood-vessel blocker, such as pembrolizumab with axitinib or lenvatinib, or nivolumab with cabozantinib. In the CheckMate 214 trial, 75 percent of patients treated with nivolumab and ipilimumab were alive at 18 months, compared with 60 percent with sunitinib, and some remain free of cancer many years later.3
From China. In the RENOTORCH trial, led from Peking University Cancer Hospital, the Chinese immunotherapy drug toripalimab with axitinib nearly doubled the time before the cancer progressed compared with sunitinib, 18.0 months compared with 9.8 months.4
When immunotherapy stops working. Belzutifan delayed progression compared with everolimus in the LITESPARK-005 trial,5 and in 2026 a combination of belzutifan with lenvatinib also succeeded in a phase 3 trial. See our articles on how immunotherapy works and what to do when treatment stops working.
Protecting the Remaining Kidney
After kidney surgery, protecting kidney function becomes part of long-term care. Regular use of anti-inflammatory pain relievers such as ibuprofen and naproxen can damage the kidneys. High-dose intravenous vitamin C is broken down partly into oxalate, which can harm weakened kidneys, so kidney function should be checked before it is used, and large doses of turmeric also contain oxalate. Staying well hydrated, controlling blood pressure, and taking care with the contrast dye used for scans all help. See our article on high-dose IV vitamin C.
Quitting smoking, regular exercise and reaching a healthy weight are the best-supported lifestyle steps. There is little trial evidence for specific supplements in kidney cancer.
How Cancer Expert MD Helps
Cancer Expert MD provides education and consultation for people with every type and stage of cancer, and specializes in Stage IV and metastatic cancer. Our book, The New Reality of Cancer, covers testing and treatment across all cancers, including how to block the pathways each cancer depends on.
Frequently Asked Questions
What is belzutifan?
A pill that blocks HIF-2α, the switch that drives blood vessel growth in most kidney cancers. In 2026, adding it to pembrolizumab after surgery reduced recurrence by 28 percent.
Is treatment needed after kidney cancer surgery?
For people at higher risk of the cancer returning, a year of pembrolizumab after surgery reduced the risk of death by 38 percent in the KEYNOTE-564 trial.
What is the first treatment for advanced kidney cancer?
Usually an immunotherapy combination, either two immunotherapy drugs together or an immunotherapy drug with a blood-vessel blocker.
How can I protect my remaining kidney?
Avoid regular use of anti-inflammatory pain relievers, check kidney function before high-dose IV vitamin C, stay hydrated, and control blood pressure.
About the author. Dr. Silver, MD, graduated from Temple University School of Medicine, trained as an interventional cardiologist, and has practiced medicine for nearly fifty years. A lymphoma survivor of about twenty-five years, he is co-author, with Dr. Lindmeier, DHSc, of The New Reality of Cancer: The Science of Recovery. Read more about Dr. Silver, MD.
Research by Dr. Lindmeier, DHSc, cancer educator and co-author of The New Reality of Cancer.
This article is for general education only and is not individual medical advice. Always consult your own doctor before making any changes to your care.
© 2026 Cancer Expert MD, Dr. Silver, MD, and Dr. Lindmeier, DHSc. All rights reserved. This article draws on the research in The New Reality of Cancer and may not be copied, republished or distributed without written permission.
For more in-depth information on this topic and many others, get our book, The New Reality of Cancer: The Science of Recovery.
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References
- Choueiri TK, Tomczak P, Park SH, et al. Overall survival with adjuvant pembrolizumab in renal-cell carcinoma. New England Journal of Medicine. 2024;390(15):1359–1371.
- LITESPARK-022 Investigators. Adjuvant pembrolizumab plus belzutifan for renal-cell carcinoma. New England Journal of Medicine. 2026;395(1):32–43.
- Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. New England Journal of Medicine. 2018;378(14):1277–1290.
- Toripalimab plus axitinib versus sunitinib as first-line treatment for advanced renal cell carcinoma (RENOTORCH): a randomized, open-label, phase III study. Annals of Oncology. 2024.
- Choueiri TK, Powles T, Peltola K, et al. Belzutifan versus everolimus for advanced renal-cell carcinoma (LITESPARK-005). New England Journal of Medicine. 2024;391(8):710–721.
This article is for education only. It is not medical advice and does not diagnose or treat any condition. Cancer Expert MD has no financial relationship with any laboratory, drug maker, supplement company, clinic or hospital.
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