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Renal Cancer pp 335–347Cite as

Adjuvant Systemic Therapy, Immunotherapy, and Targeted Treatment

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Abstract

For many years the standard treatment for metastatic renal cell carcinoma (mRCC) was based on the cytokines interleukin-2 (IL-2) and interferon-α (IFN-α), because the immune system was thought to play a key role in the natural history of this disease. Unfortunately, with these treatments only some patients benefitted in terms of overall survival (OS), and many suffered their toxicities. Currently, their use is limited to a very small selected category of patients. In the past few years, seven new molecular targeted agents have been approved by the US Food and Drug Administration (FDA) and in Europe by the European Medicines Agency (EMA) for the treatment of mRCC. These targeted drugs, tyrosine kinase inhibitors (TKIs) and VEGF-inhibitors, are sunitinib, pazopanib, sorafenib, axitinib, and bevacizumab plus interferon. In addition, inhibition of the rapamycin complex in mammals (mTOR) represents an important therapeutic target in mRCC. Two drugs, everolimus and temsirolimus, have demonstrated improved outcomes. The main focus of current research has concentrated on managing the side effects of these therapies and evaluating their possible use in the adjuvant setting. Results in the adjuvant setting must be extremely promising or patients and physicians will be reluctant to employ these agents in otherwise “healthy” patients. Important topics in which to focus research include better understanding of the genetic differences among populations in order to understand their ability to respond to individual drugs and their individual possibilities of suffering from toxicity. Novel immunotherapeutic agents targeting the PD-1/PD-L1 pathway on the near horizon hold future promise.

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Authors and Affiliations

  1. Department of Medical Oncology, San Camillo and Forlanini Hospitals, Circonvallazione Gianicolense 87, 00152, Rome, Italy

    Linda Cerbone & Cora N. Sternberg M.D., FACP

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  1. Linda Cerbone
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  2. Cora N. Sternberg M.D., FACP
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Correspondence to Cora N. Sternberg M.D., FACP .

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  1. , Institute of Urology, Lahey Clinic, 41 Mall Road, Burlington, 01805, Massachusetts, USA

    John A Libertino

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Cerbone, L., Sternberg, C.N. (2013). Adjuvant Systemic Therapy, Immunotherapy, and Targeted Treatment. In: Libertino, J. (eds) Renal Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7236-0_20

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  • DOI: https://doi.org/10.1007/978-1-4614-7236-0_20

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