Renal Cancer Treatment: A Review of the Literature

Abstract

Renal carcinoma represents about 3% of all adult tumors, with an estimate of 31,900 new cases diagnosed in 2003 in the United States. In the early phase of its natural history, renal cancer is potentially curable by surgery, but if the disease presents any signs of metastasis, the chances of survival are remote, even though anecdotal cases characterized by long survival have been reported. In fact, the treatment of metastatic renal cancer remains unsatisfactory. Systemic treatment with single agents and with polychemotherapy, with or without cytokine-based immunotherapy, has not been successful, obtaining very low response rates without a significant benefit in overall survival. This review highlights the most interesting issues regarding conventional therapeutic strategies, in localized and in advanced disease. New approaches such as monoclonal antibodies, vaccines, gene therapy, angiogenesis inhibitors and allogeneic cell transplantation and their possible clinical applications are also discussed.

Tratamiento de los tumores renales localmente avanzados

“…La nefrectomía radical consiste en la extracción "en bloque" del riñón, conjuntamente con la grasa perirrenal, glándula suprarrenal y fascia de Gerota. Las vías de abordaje pueden variar dependiendo de la localización del tumor, su tamaño, las características del paciente e incluso las preferencias por parte del cirujano 12 . Los principales accesos en la actualidad son el transperitoneal (vía anterior), el retroperitoneal (lumbotomía), toracoabdominal y laparoscópico.…”

Unilateral Kidney-Selective Gene Transfer Following the Administration of Naked Plasmid DNA to the Kidney Surface in Mice

“…33,34) Kidney-targeted gene therapy is expected to treat fatal diseases, including renal cell carcinoma, chronic renal fibrosis and glomerulonephritis. [35][36][37] Therefore, the present study was undertaken to elucidate the unilateral kidney-selective gene transfer following the administration of naked pDNA to the surface of mouse kidney. …”

Cytochrome P450 CYP1B1 activity in renal cell carcinoma

“…Although RCC is a highly vascular tumour and extracellular drug delivery is probably high (Yagoda et al, 1995), chemotherapy is largely ineffective, and response rates to cytotoxic therapy are only 5 -15% (Chapman and Goldstein, 1995). Indeed, the response of RCC to the alkylating agents (nitrosoureas, melphalan, cyclophosphamide and ifosphamide) is very low (Gattinoni et al, 2003). Docetaxel, vinblastine and the 5 0 -fluoropyrimidines have all been highlighted as effective single agents for metastatic disease, but the response rate is still only 20% (Gattinoni et al, 2003).…”

“…Indeed, the response of RCC to the alkylating agents (nitrosoureas, melphalan, cyclophosphamide and ifosphamide) is very low (Gattinoni et al, 2003). Docetaxel, vinblastine and the 5 0 -fluoropyrimidines have all been highlighted as effective single agents for metastatic disease, but the response rate is still only 20% (Gattinoni et al, 2003). Resistance of RCC to anticancer drugs is considered to be due in part to the activity of the superfamily of drug efflux pumps, which are responsible for 'classical' multidrug resistance; p-glycoprotein (also known as MDR1 (multidrug resistance) in human beings) was the first of this superfamily to be identified.…”

“…Resistance of RCC to anticancer drugs is considered to be due in part to the activity of the superfamily of drug efflux pumps, which are responsible for 'classical' multidrug resistance; p-glycoprotein (also known as MDR1 (multidrug resistance) in human beings) was the first of this superfamily to be identified. Several treatments including agents that alter MDR (acrivastine, nifedipine, cyclosporin A and other derivatives such as PSC833, quinidine and verapamil) and immunotherapy (using interleukin 2 and interferon a) have been proposed as prospective new therapies for RCC; however, the results have been disappointing (Gattinoni et al, 2003). Indeed, cancers of the kidney are considered to be among the most unresponsive to treatment and intrinsically drug resistant of all human cancers (Yagoda et al, 1995), and RCC remains fatal in nearly 80% of patients.…”