Recent advances in the systemic management of non-clear cell renal cell carcinoma: a review article

Abstract

Non-clear cell renal cell carcinoma (nccRCC) is not as common as clear cell renal cell carcinoma (ccRcc). But then it is not uncommon in regular urological practice. It usually carries a grave prognosis. Authors need to converse ourselves with National comprehensive cancer network (NCCN) categories for evidence and we need to converse as well with NCCN categories for preferences. ‘Preferred intervention’ is based on superior efficacy, safety and evidence and when appropriate, affordability. ‘Other recommended interventions’ are somewhat less efficacious, more toxic, or based on less mature data or significantly less affordable for similar outcomes. ‘Useful in certain circumstances’ are interventions that may be used for a selected patient population. Clinical trials for targeted agents are mainly directed at ccRCC because of its high prevalence. According to the NCCN panel, enrolment in clinical trials is the preferred strategy for nccRCC. Outcomes of patients with nccRCC have improved with the introduction of targeted therapy. Precise pathological diagnosis of the types of nccRCC by immunohistochemical analysis is mandatory. This enables specific treatments for individual nccRCC. Currently TKIs are the drug of choice (both first and second line) for metastatic papillary RCC. Both TKIs and mTOR inhibitors are effective against chromophobe RCC. Platinum based chemotherapy should be used for metastatic CDC. Further evidence is required for management of nccRCC.