Precision Medicine: An Optimal Approach to Patient Care in Renal Cell Carcinoma

Abstract

Renal cell cancer (RCC) is a heterogeneous tumor that shows both intra- and inter-heterogeneity. Heterogeneity is displayed not only in different patients but also among RCC cells in the same tumor, which makes treatment difficult because of varying degrees of responses generated in RCC heterogeneous tumor cells even with targeted treatment. In that context, precision medicine (PM), in terms of individualized treatment catered for a specific patient or groups of patients, can shift the paradigm of treatment in the clinical management of RCC. Recent progress in the biochemical, molecular, and histological characteristics of RCC has thrown light on many deregulated pathways involved in the pathogenesis of RCC. As PM-based therapies are rapidly evolving and few are already in current clinical practice in oncology, one can expect that PM will expand its way toward the robust treatment of patients with RCC. This article provides a comprehensive background on recent strategies and breakthroughs of PM in oncology and provides an overview of the potential applicability of PM in RCC. The article also highlights the drawbacks of PM and provides a holistic approach that goes beyond the involvement of clinicians and encompasses appropriate legislative and administrative care imparted by the healthcare system and insurance providers. It is anticipated that combined efforts from all sectors involved will make PM accessible to RCC and other patients with cancer, making a tremendous positive leap on individualized treatment strategies. This will subsequently enhance the quality of life of patients.

ABCC2 brush‐border expression predicts outcome in papillary renal cell carcinoma: a multi‐institutional study of 254 cases

“…In the era of precision medicine, identification of biomarkers that have a predictive value for targeted therapies may improve clinical outcomes 2 . ABCC2 is part of the family of ABC transporter/multidrug resistance proteins, implicated in chemotherapy resistance in various tumours 21–24 .…”

“…Renal cell carcinoma (RCC), which arises from renal tubular epithelial cells is the most common kidney tumour in adults and ~15% of RCCs, are papillary renal cell carcinoma (PRCC). PRCC is the second most common type of RCC, following clear‐cell RCC (CCRCC) 1,2 . Compared to CCRCC, PRCC displays a worse prognosis in advanced or disseminated disease 3 …”

Effects and Prognostic Values of Circadian Genes CSNK1E/GNA11/KLF9/THRAP3 in Kidney Renal Clear Cell Carcinoma via a Comprehensive Analysis

“…Kidney renal clear cell carcinoma (KIRC) is the most common histological subtype of renal cell carcinoma, accounting for 80–90% of all cases, with a high degree of immune infiltration [ 1 , 2 , 3 ]. A better understanding of the immune system and a discovery that tumors can take advantage of immune checkpoints to promote their survival and growth have resulted in the creation of immune checkpoint inhibitors (ICIs) [ 4 ]. Immune checkpoint inhibitors, either alone or in combination, are the new standard of care for treating KIRC, and the rapidly evolving state of systemic therapy for KIRC has prompted clinicians to think about extending immunotherapy to the earlier stages of the disease [ 5 ].…”

“…that tumors can take advantage of immune checkpoints to promote their survival and growth have resulted in the creation of immune checkpoint inhibitors (ICIs) [4]. Immune checkpoint inhibitors, either alone or in combination, are the new standard of care for treating KIRC, and the rapidly evolving state of systemic therapy for KIRC has prompted clinicians to think about extending immunotherapy to the earlier stages of the disease [5].…”

Sequential treatment of metastatic renal cell carcinoma patients after first-line vascular endothelial growth factor targeted therapy in a real-world setting: epidemiologic, noninterventional, retrospective–prospective cohort multicentre study

“…Despite the progress made in mRCC management, the disease eventually affects patients' quality of life and survival. The high variability of RCC subtypes makes it a candidate for a personalized medicine approach (Sharma et al 2022). Hence, discovering genetic and molecular biomarkers is crucial for precision therapy in mRCC.…”