State-of-the-Art Management of Renal Cell Carcinoma

Abstract

In the United States, renal cell cancer (RCC) is the third most common genitourinary tumor and the seventh most common cancer. Standard treatment of the primary tumor in RCC is complete resection by either a radical or partial nephrectomy which can be done as an open procedure or laparoscopically. Given the increasing incidence in the diagnosis of early-stage RCC and the toxicity and invasiveness associated with surgery, less invasive options (eg, radiofrequency ablation) have been used recently as an alternative. Although conventional radiotherapy plays a role in the palliative setting, its role is otherwise limited. This is partly because of the in vitro and clinical data showing that RCC is relatively radioresistant to radiotherapy. The advances in immobilization and image guidance have led several investigators to consider stereotactic techniques to overcome this resistance with impressive results in the metastatic setting. Recent retrospective and prospective phase II trials of RCC stereotactic body radiotherapy have shown excellent local controls up to 90% to 98%. Given these results and the noninvasive nature of stereotactic body radiotherapy this modality should be further evaluated as a treatment of choice for the primary RCC tumor. Although RCC is also resistant of conventional chemotherapy agents, exciting recent advances have emerged in the treatment of systemic disease with the development of targeted agents in addition to immunotherapy-based treatments. In the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the 2 modalities.

The effect of liposomal size on the targeted delivery of doxorubicin to Integrin αvβ3-expressing tumor endothelial cells

“…Hence, the availability of DOX would be 90x10 -8 ng/tumor cell (Fig. 7), which is about 2600 times lower than the dose found in the in vitro situation, indicating that, to kill 20% of the tumor cells in an RCC tumor, a ~2600 times higher amount of Doxil 25 would be required, which is a practical impossibility. Therefore, an insufficient amount of DOX in tumor cells delivered by Doxil fails to provide a sufficient anti-tumor effect.…”

“…The effect of the size of PEG-LPs on cellular internalization, ligand-receptor interactions as well as on in vitro drug delivery efficiency was evaluated using human umbilical vein endothelial cells (HUVEC) that express Integrin v3 [22]. To observe the tissue distribution as well as the therapeutic effect, size controlled PEG-LPs were applied to mice bearing kidney cancer (human RCC), which is notoriously resistant to chemotherapy [23][24][25][26][27], where various multidrug-resistant proteins are responsible for drug resistance. Because of this, it would be difficult to treat RCC by delivering a drug to tumor cells.…”

The Expression of Fibroblast Activation Protein in Clear Cell Renal Cell Carcinomas Is Associated with Synchronous Lymph Node Metastases

“…Clear cell renal cell carcinoma (CCRCC) is the most common histological subtype, accounting approximately for 75–80% of the cases [3]. CCRCC is frequently resistant to current chemo- and radiotherapy, and the standard treatment is complete resection of the primary tumor by radical or partial nephrectomy [4]. …”

Web-based tools for microRNAs involved in human cancer

“…Renal cell carcinoma (RCC) is a common and often lethal urological cancer complicated by resistance to chemotherapy and radiotherapy (58). Although several molecular markers have been identified for RCC diagnosis and prognosis, it is not possible to predict tumor aggressiveness and metastasis (59).…”