Current Management of Renal Cell Carcinoma and Targeted Therapy

• Main Authors: A Erdem Canda, Ziya Kirkali
• Format: Article
• Language: English
• Published: Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences 2006-03-01
• Series: Urology Journal
• Online Access: http://www.urologyjournal.org/index.php/uj/article/view/208/205

<pre style="tab-stops: -420.0pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="TR">Introduction:</span></strong><span style="font-family: " lang="TR"> The aim of this review is to provide an update on the current management of renal cell carcinoma (RCC) and targeted molecular therapy for metastatic RCC. </span></span></pre><p class="MsoNormal" style="margin: 0cm 0cm 0pt; direction: ltr; unicode-bidi: embed; text-align: left; tab-stops: -420.0pt; mso-layout-grid-align: none;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;">Materials and Methods:</strong> A Pubmed database search was performed using the keywords<span style="mso-bidi-font-size: 10.0pt;"> “renal cell carcinoma, treatment, management, l</span>ocalized disease, metastatic disease and<span style="mso-bidi-font-size: 10.0pt;"> targeted therapy” covering 1995 to 2006. The most recent articles published having clinical relevance were reviewed for the preparation of this paper. </span></span></span></p><p class="MsoBodyText" style="margin: 0cm 0cm 0pt; line-height: normal; text-align: left; tab-stops: -420.0pt;" align="left"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="font-style: normal; color: black;">Results: </span></strong><span style="font-style: normal; color: black;">Surgery is considered as the only curative treatment for localized RCC. Currently, open radical nephrectomy is mainly performed in patients with large tumor size, locally advanced tumors and tumor thrombus extending into the vena cava. Nephron sparing surgery (NSS) is the most commonly performed procedure with excellent local cancer control in small, resectable renal tumors. Increasingly, laparoscopy is being performed and now recommended for early-stage RCCs unsuitable for NSS. Laparoscopic radical nephrectomy seems to be providing long-term cancer control comparable to open radical nephrectomy. Laparoscopic NSS is now available particularly in patients with a relatively small and peripheral renal tumor. The current therapy for metastatic RCC is inadequate and surgery is an important component of the treatment with combined immunotherapy in which response rates remain at about 15% to 25%. </span><span style="font-style: normal; color: black;">In the past several years, significant advances in the underlying biological mechanisms of RCC development have permitted the design of new molecularly targeted therapeutics </span><span style="font-style: normal; color: black;">such as antibodies, tumor vaccines, anti-angiogenesis agents and small molecule tyrosine kinase inhibitors in order to improve treatment options.<strong style="mso-bidi-font-weight: normal;"></strong></span></span></span></p><p class="MsoBodyText" style="margin: 0cm 0cm 0pt; line-height: normal; text-align: left;" align="left"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="font-style: normal;">Conclusion: </span></strong><span style="font-style: normal;">Surgery is the only curative treatment for localized RCC and NSS cures most of the patients with early-stage disease. Currently laparoscopy is recommended for early-stage RCCs unsuitable for NSS. </span><span style="font-style: normal; mso-bidi-font-size: 9.5pt;">Better understanding of the molecular pathways of carcinogenesis in RCC leads to the discovery of new drugs which can prolong survival</span><span style="font-style: normal;"> in metastatic RCC.</span></span></span></p>