Current Treatment Options in Oncology

, Volume 4, Issue 5, pp 385–390 | Cite as

Metastatic renal cell carcinoma

  • Robert C. Flanigan
  • Steven C. Campbell
  • Joseph I. Clark
  • Maria M. Picken

Opinion statement

Patients with renal cell cancer (RCC) develop metastatic spread in approximately 33% of cases. The clinical management of patients with metastatic RCC is complicated by the lack of significant efficacy from available therapies. Common sites of metastases include the lung, liver, bone, brain, and adrenal gland, with case reports detailing the capacity of RCC to appear almost anywhere in the body. More than one organ system is often involved in the metastatic process. Metastases may be found at diagnosis or at some interval after nephrectomy. Approximately 20% to 50% of patients will eventually develop metastatic disease after nephrectomy. A shorter interval between nephrectomy and the development of metastases is associated with a poorer prognosis. Patients with metastatic RCC face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10% to 20%. Recent advances in biologic response modifier therapy have brought new hope to a small percentage of patients who respond to this therapy and rekindled interest in cytoreductive nephrectomy as an integral part of the management of these patients.


Vascular Endothelial Growth Factor Renal Cell Carcinoma Renal Cell Cancer Metastatic Renal Cell Carcinoma Flavopiridol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Greenlee RA, Murray T, Bolden S, et al.: Cancer statistics, 2000. CA Cancer J Clin 2000, 50:7–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Chow W, Devesa S, Warren J, Fraumeri J: Rising incidence of renal cell cancer in the United States. JAMA 1999, 281:1628–1631. The rising incidence of RCC in the United States is provocative. Based on current data, this increase seems to be occurring in local and distant disease.PubMedCrossRefGoogle Scholar
  3. 3.
    Skinner DG, Colvin RV, Vermillion CD, et al.: Diagnosis and management of renal cell carcinoma: a clinical and pathological study of 309 cases. Cancer 1971, 28:1165–1177.PubMedCrossRefGoogle Scholar
  4. 4.
    Meloni-Ehrig AM: Renal cancer: cytogenetic and molecular genetic aspects. Am J Med Genet 2002, 115:164–172.PubMedCrossRefGoogle Scholar
  5. 5.
    Gnarra JR, Lerman MI, Zbar B, Linehan WM: Genetics of renal-cell carcinoma and evidence for a critical role for von Hippel-Lindau in renal tumorigenesis. Semin Oncol 1995, 22:3–8.PubMedGoogle Scholar
  6. 6.
    Linehan WM, Lerman MI, Zbar B: Identification of the von Hippel-Lindau (VHL) gene: its role in renal cancer. JAMA 1995, 273:564–570. This hallmark paper discusses the VHL gene and its implication in VHL diseases and sporadic RCC.PubMedCrossRefGoogle Scholar
  7. 7.
    Levy AP, Levy NS, Iliopoulos O, et al.: Regulation of vascular endothelial growth factor by hypoxia and its modulation by the von Hippel-Lindau tumor suppressor gene. Kidney Int 1997, 51:575–578.PubMedCrossRefGoogle Scholar
  8. 8.
    Thrasher JB, Paulson DF: Prognostic factors in renal cancer. Urol Clin North Am 1993, 2:247–262.Google Scholar
  9. 9.
    Libertino JA, Zinman L, Watkins E Jr: Long-term results of resection of renal cell cancer with extension into inferior vena cava. J Urol 1987, 137:21–24.PubMedGoogle Scholar
  10. 10.
    Bassil B, Dosoretz DE, Prout GR Jr: Validation of the tumor, nodes, and metastasis classification of renal cell carcinoma. J Urol 1985, 134:450–454.PubMedGoogle Scholar
  11. 11.
    Flanigan RC, Salmon SE, Blumenstein BA, et al.: Nephrectomy followed by interferon alfa-2b compared to interferon alfa-2b alone for metastatic renal cell cancer. N Engl J Med 2001, 345:1655–1659. This paper represents the first prospective randomized trial demonstrating the role of cytoreductive nephrectomy in metastatic RCC. The outcomes are stratified by pretreatment stratification variables.PubMedCrossRefGoogle Scholar
  12. 12.
    Fuhrman SA, Lasky LC, Limas C: Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982, 6:655–663.PubMedCrossRefGoogle Scholar
  13. 13.
    Zisman A, Pantuck AJ, Wieder J, et al.: Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol 2002, 20:4559–4566. Based on the extensive experience at UCLA (Los Angeles, CA) with RCC, the authors have developed a useful schema for the prediction of outcomes.PubMedCrossRefGoogle Scholar
  14. 14.
    Motzer R, Russon P: Systemic therapy for renal cell carcinoma. J Urol 2000, 163:408–417.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson DE, Kaesler KE, Samuels ML: Is nephrectomy justified in patients with metastatic renal carcinoma? J Urol 1975, 114:27–29.PubMedGoogle Scholar
  16. 16.
    Elson PR, Witte RS, Trump DL: Prognostic factors for survival in patients with recurrent or metastatic renal cell carcinoma. Cancer Res 1988, 48:7310–7313.PubMedGoogle Scholar
  17. 17.
    Negrier S, Escudier B, Lasset C, et al.: Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal cell carcinoma. N Engl J Med 1998, 338:1272–1278.PubMedCrossRefGoogle Scholar
  18. 18.
    Couillard DR, DeVere White RW: Surgery of renal cell carcinoma. Urol Clin North Am 1993, 20:263–275.PubMedGoogle Scholar
  19. 19.
    Freed S: Nephrectomy for renal cell carcinoma with metastases. Urology 1977, 6:613–616.CrossRefGoogle Scholar
  20. 20.
    Walther MM, Alexander RB, Weiss GH: Cytoreductive surgery prior to interleukin-2-based therapy in patients with metastatic renal cell carcinoma. Urology 1993, 42:250–257.PubMedCrossRefGoogle Scholar
  21. 21.
    DeKernion JB, Lindner A: Treatment of advanced renal cell carcinoma. Prog Clin Biol Res 1982, 100:641–659.PubMedGoogle Scholar
  22. 22.
    Kavolius DP, Mastorakos C, Pavlovich P, et al.: Resection of metastatic renal cell carcinoma. J Clin Oncol 1998, 16:2261–2266.PubMedGoogle Scholar
  23. 23.
    Yagoda A: Phase II cytotoxic chemotherapy trials in RCC: 1983-1988. Prog Clin Biol Res 1990, 350:227–241.PubMedGoogle Scholar
  24. 24.
    Figlin RA: Renal cell carcinoma: management of advanced disease [abstract]. J Urol 1999, 161:381a.CrossRefGoogle Scholar
  25. 25.
    Gitlitz BJ, Belldegrun A, Figlin R: Immunotherapy and gene therapy. Semin Urol Oncol 1996, 14:237–243.PubMedGoogle Scholar
  26. 26.
    Bukowski RM: Natural history and therapy of metastatic renal cell carcinoma. Cancer 1997, 80:1198–1220.PubMedCrossRefGoogle Scholar
  27. 27.
    Spencer WF, Linehan WM, Walther MM, et al.: Immunotherapy with interleukin-2 and interferon in patients with metastatic renal cell cancer in situ primary cancers: a pilot study. J Urol 1992, 147:24–30.PubMedGoogle Scholar
  28. 28.
    Flanigan RC: Role of surgery in patients with metastatic renal cell carcinoma. Semin Urol Oncol 1996, 14:227–229.PubMedGoogle Scholar
  29. 29.
    Fyfe G, Fisher RI, Rosenberg SA, et al.: Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol 1995, 13:688–696.PubMedGoogle Scholar
  30. 30.
    Motzer RJ, Bacik J, Mariani T, et al.: Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear cell histology. J Clin Oncol 2002, 20:2376–2381. This interesting manuscript describes the behavior of nonclear cell RCC. This is valuable information in the era of increased appreciation of the various types of RCC and their individual characteristics.PubMedCrossRefGoogle Scholar
  31. 31.
    Mickisch GH, Garin A, van Poppel H, et al.: Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal cell carcinoma. Lancet 2001, 358:966–970. This prospective randomized trial of cytoreductive nephrectomy was done by the European Organization for Research and Treatment of Cancer and uses the SWOG protocol [15]. It provides additional useful support of the concept of cytoreductive nephrectomy.PubMedCrossRefGoogle Scholar
  32. 32.
    van Veldhuizen PJ, Faulkner JR, Lara PN, et al.: A phase II study of flavopiridol (Flavo) in patients with advanced renal cell cancer: results of Southwest Oncology Group trial S0109 [abstract]. Am Soc Clin Oncol 2003:1552a.Google Scholar
  33. 33.
    Childs R, Chernoff A, Contentin N, et al.: Regression of metastatic renal cell carcinoma after nonmyeloablative allogenic peripheral blood stem cell transplantation. N Engl J Med 2000, 343:750–758. Miniallotransplantation provides a new and interesting look at the biologic behavior of metastatic RCC and a useful technique for patients with this disease. The toxicity and early success of this concept is discussed.PubMedCrossRefGoogle Scholar
  34. 34.
    Nakagawa M, Emoto A, Hanada T, et al.: Tubulogenesis by microvascular endothelial cells is mediated by vascular endothelial growth factor (VEGF) in renal cell carcinoma. Br J Urol 1997, 79:681–687.PubMedGoogle Scholar
  35. 35.
    Amare Kadam PS, Varghese C, Bharde SH, et al.: Proliferating cell nuclear antigen and epidermal growth factor receptor (EGFr) status in renal cell carcinoma patients with polysomy of chromosome 7. Cancer Genet Cytogenet 2001, 125:139–146.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Robert C. Flanigan
    • 1
  • Steven C. Campbell
  • Joseph I. Clark
  • Maria M. Picken
  1. 1.Department of UrologyLoyola University Medical Center, Cardinal Bernardin Cancer Center and Hines VA HospitalMaywoodUSA

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