Renal cell carcinoma (RCC) is a common genitourinary cancer, with approximately 400 000 cases diagnosed worldwide in 2018 [1]. Surgical resection remains the most effective treatment since RCC has historically demonstrated resistance to chemotherapy and radiation. While a surgical cure is feasible for most early-stage tumors, recurrence after surgery can occur in up to 40% of cancers with high-risk features [2]. Thus, it is clear that surgery alone cannot eradicate disease in some high-risk cases, and therefore the rationale for adjuvant systemic therapy is sound.Multiple treatment modalities have been investigated for use following surgery for patients with locoregional RCC. Early attempts included radiation, chemotherapy, and hormonal treatments, none of which showed a treatment benefit [3]. In the early 2000s the focus shifted towards adjuvant immunotherapy, mirroring the contemporaneous management of metastatic RCC. Several randomized trials were conducted on the use of adjuvant interferon and IL-2; however, no survival advantage was seen with these agents [3].The rapid expansion of targeted systemic therapies and their efficacy in treating metastatic RCC resulted in exploration of their application in the adjuvant setting. These agents target common mutations in clear cell RCC, specifically the von Hippel Lindau protein, which drives upregulation of tumor angiogenesis pathways such as VEGF. Tyrosine kinase inhibitors (TKIs) (eg, sunitinib, sorafenib, pazopanib, and axitinib) target and block VEGFR, thereby slowing tumor angiogenesis and growth. AbstractCancer recurs in up to 40% of patients following surgery for high-risk, locoregional renal cell carcinoma (RCC). To date, little progress has been made in identifying systemic adjuvant treatment options to reduce the mortality risk after surgery for high-risk RCC. Several randomized trials exploring the efficacy of adjuvant targeted therapies in the postoperative setting have recently reported results. We examine these trials to assess the contemporary role of targeted therapy following surgery in high-risk RCC and briefly consider trials that are currently accruing with a focus on immunotherapy agents in the adjuvant setting. Patient summary: Kidney cancer often recurs despite initial surgery in patients with high-risk tumors. So far, adding systemic treatments such as targeted therapies after surgery has not resulted in improved survival outcomes. Future studies that include immunotherapy after surgery to reduce the risk of recurrence in patients with high-risk disease are eagerly anticipated.

Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. Although laparoscopy has been widely adopted for management of benign adrenal tumors, minimally invasive surgery for ACC remains controversial. Retrospective analyses, frequently with fewer than one hundred participants, comprise the majority of the literature. High-quality data regarding the optimal surgical approach for ACC are lacking due to the rarity of the disease and the fact that determination of tumor type (e.g., adenoma or carcinoma) is determined after adrenalectomy, since adrenal tumors are generally not biopsied. While the benefits of minimally invasive surgery including lower intra-operative blood loss and decreased hospital length-of-stay have been consistently demonstrated, clinical equipoise for long-term survival and recurrence outcomes between open and minimally invasive adrenalectomy (MIA) remains. This review examines retrospective studies that directly compare patients with ACC who underwent either open or laparoscopic adrenalectomy, and considers these findings in the context of current guideline recommendations for surgical management of ACC.

Adenosquamous carcinoma is an extremely rare and lethal subtype of prostate cancer affecting an estimated 0.03 per million men annually. It has been associated with prior hormone therapy for prostate adenocarcinoma. We present a case of de novo adenosquamous carcinoma of the prostate treated with a multimodal approach including surgery, androgen-deprivation therapy, chemotherapy, and radiation.

Investigation of novel circulating proteins, germ line single-nucleotide polymorphisms, and molecular tumor markers as potential efficacy biomarkers of first-line sunitinib therapy for

Locally and regionally advanced renal cell carcinoma (RCC) can recur at high rates even after visually complete resection of primary disease. Both targeted therapies and immunotherapies represent potential agents that might help reduce recurrence of RCC in these patients. This paper reviews the current body of evidence defining their potential impact and examines the large Phase III randomized clinical trials that have been performed to assess the safety and efficacy of these systemic therapies in the adjuvant setting. Given that the findings from these trials have been predominantly negative, this paper also explores the role of other potential adjuvant agents, including single and combination agent targeted therapies and immunotherapies, whose use is currently limited to metastatic RCC. Finally, the use of radiation therapy and the use of advanced imaging modalities in RCC are also considered.