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2016 ; 115
(5
): 505-16
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Medical treatment of renal cancer: new horizons
#MMPMID27490806
Greef B
; Eisen T
Br J Cancer
2016[Aug]; 115
(5
): 505-16
PMID27490806
show ga
Renal cell carcinoma (RCC) makes up 2-3% of adult cancers. The introduction of
tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors in
the mid-2000s radically changed the management of RCC. These targeted treatments
superseded immunotherapy with interleukin-2 and interferon. The pendulum now
appears to be shifting back towards immunotherapy, with the evidence of prolonged
overall survival of patients with metastatic RCC on treatment with the
anti-programmed cell death 1 ligand monoclonal antibody, nivolumab. Clinical
prognostic criteria aid prediction of relapse risk for resected localised
disease. Unfortunately, for patients at high risk of relapse, no adjuvant
treatment has yet shown benefit, although further trials are yet to report.
Clinical prognostic models also have a role in the management of advanced
disease; now there is a pressing need for predictive biomarkers to direct
therapy. Treatment selection for metastatic disease is currently based on
histology, prognostic group and patient preference based on side effect profile.
In this article, we review the current medical and surgical management of
localised, oligometastatic and advanced RCC, including side effect management and
the evidence base for management of poor-risk and non-clear cell disease. We
discuss recent results from clinical trials and how these are likely to shape
future practice and a renaissance of immunotherapy for renal cell cancer.
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