Adjuvant and Neoadjuvant Therapy in Renal Cell Carcinoma

Abstract

Nephrectomy continues to be the cornerstone of treatment for localized renal cell carcinoma (RCC). Despite undergoing nephrectomy, recurrence of disease remains a concern in many patients, and different medical therapies are being investigated as means to decrease this risk. The use of the traditional immunotherapy options has not provided benefit as adjuvant treatment in this disease state. Recently, the treatment of metastatic RCC has experienced key advances with the introduction of targeted agents against the vascular endothelial growth factor (VEGF) molecule and related pathways as well as inhibitors of the mammalian target of rapamycin (mTOR), in addition to improvements in surgical technique. Additionally, there are questions about the optimal timing of systemic therapy in the context of high risk non-metastatic disease. There is optimism that locally advanced RCC might benefit from adjuvant or neoadjuvant treatment with these therapies. Ongoing clinical trials are addressing the role of targeted agents in this disease state.

Identification of Novel Proteins Interacting with Vascular Endothelial Growth Inhibitor 174 in Renal Cell Carcinoma

“…At the time of RCC diagnosis, metastatic lesions are present in 20-30% of patients (20,21). Also, in 20-30% of patients with preoperative absence of metastases, after nephrectomies metastatic lesions appear or local recurrence of disease take places (22,23). Surgical treatment of kidney tumors is the only effective treatment modality.…”

Prognostic Factors in Renal Cell Carcinoma: An Evaluation of T-Stage, Histopathological Grade, p53, Ki-67, COX-2, and Her-2 Expressions

“…Ongoing clinical trials are addressing the role of targeted agents in adjuvant therapy in RCC (Choueiri et al 2011). The efficacy of many potent novel targeted agents in RCC is under investigation in phase II and III trials, among these axitinib, a multitargeted tyrosine kinase receptor inhibitor (Goldstein et al 2010), tivozanib, a pan-VEGFR tyrosine kinase inhibitor (De Luca and Normanno 2010), and ipilimumab, an anti-CTLA4 antibody (Yang et al 2007).…”

Development and Validation of a Prognostic Nomogram for Progression-Free Survival in Patients with Advanced Renal Cell Carcinoma Treated with Pazopanib

“…Approximately 90% of all kidney cancers may be classified as RCC, with up to 80% having clear-cell histology [1,2]. More than 75% of RCC patients present with locally advanced or metastatic disease [3].…”