Summary
Renal cell cancer (RCC) accounts for 2% of all malignancies. RCC shows a rising incidence and overall mortality is the highest among all urologic malignancies. In localised disease, radical cancer surgery remains the only potential curative treatment option. Indications for nephron-sparing surgery include renal tumours 4 cm or less in diameter and patients with solitary kidneys or bilateral synchronous RCC. Nephron-sparing surgery is also recommended in patients with conditions that might lead to impaired kidney function later on. In metastatic RCC (mRCC), cytoreductive surgery followed by the immunotherapy has proven to be a mainstay in patients with a good performance status. Chemotherapy has no role in the treatment of mRCC. Pharmacological treatment of mRCC has significantly changed in the last months due to the approval of targeted therapies such as sunitinib, sorafenib, bevacizumab or temsirolimus, which have largely replaced immunotherapy. Immunological therapy has been the standard of care in the treatment of mRCC in the last decade. Sequencing therapy and combination of different treatment modalities may further increase therapeutic options in the future. The purpose of the following short review is to summarize the contemporary treatment options in localised and metastatic RCC.
Similar content being viewed by others
References
Karumanchi SA, Merchan J, Sukhatme VP. Renal cancer: molecular mechanisms and newer therapeutic options. Curr Opin Nephrol Hypertens, 11: 37–42, 2002
Chow WH, Devesa SS, Warren JL, et al. Rising incidence of renal cell cancer in the United States. JAMA, 281: 1628–1631, 1999
Wszolek MF, Wotkowicz C, Libertino JA. Surgical management of large renal tumours. Nat Clin Pract Urol, 5: 35–46, 2008
Klatte T, Patard JJ, de Martino M, et al. Tumour size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol, 179: 1719–1726, 2008
Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol, 89: 37–42, 1963
Kuczyk M, Münch T, Machtens S, et al. The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience. BJU Int, 89: 517–522, 2002
Ljungberg B, Hanbury DC, Kuczyk MA, et al. European Association of Urology Guideline Group for renal cell carcinoma. Renal cell carcinoma guideline. Eur Urol, 51: 1502–1510, 2007
Blom JH, van Poppel H, Marecha JM, et al. Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomised phase III protocol 30881 EORTC Genitourinary Group. Eur Urol, 36: 570–575, 1999
Castilla EA, Liou LS, Abrahams NA, et al. Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology, 60: 993–997, 2002
Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol, 179: 468–471, 2008
Messing EM, Manola J, Wilding G, et al. Eastern Cooperative Oncology Group/Intergroup trial. Phase III study of interferon alfa-NL as adjuvant treatment for resectable renal cell carcinoma: an Eastern Cooperative Oncology Group/Intergroup trial. J Clin Oncol, 21: 1214–1222, 2003
Clark JI, Atkins MB, Urba WJ, et al. Adjuvant high-dose bolus interleukin-2 for patients with high-risk renal cell carcinoma: a cytokine working group randomised trial. J Clin Oncol, 21: 3133–3140, 2003
van der Poel HG, Roukema JA, Horenblas S, et al. Metastasectomy in renal cell carcinoma: a multicenter retrospective analysis. Eur Urol, 35: 197–203, 1999
Flanigan RC, Mickisch G, Sylvester R, et al. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol, 171: 1071–1076, 2004
Motzer RJ, Russo P. Systemic therapy for renal cell carcinoma. J Urol, 163: 408–417, 2000
Coppin C, Porzsolt F, Awa A, et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev. 2005 Jan 25: CD001425, 2005
Yang JC, Sherry RM, Steinberg SM, et al. Randomised study of high-dose and low-dose interleukin-2 in patients with metastatic renal cancer. J Clin Oncol, 21: 3127–3132, 2003
Negrier S, Escudier B, Lasset C, et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Français d'Immunothérapie. N Engl J Med, 338: 1272–1278, 1998
Iliopoulos O, Levy AP, Jiang C, et al. Negative regulation of hypoxia-inducible genes by the von Hippel-Lindau protein. Proc Natl Acad Sci, 93: 10595–10599, 1996
Chow LQ, Eckhardt SG Sunitinib: From rational design to clinical efficacy. J Clin Oncol, 25: 884–896, 2007
Motzer RJ, Bacik J, Murphy BA. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol, 20: 289–296, 2002
Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med, 356: 115–124, 2007
Figlin RA, Hutson TE, Tomczak P, et al. Overall survival with sunitinib versus interferon (IFN)-alfa as first-line treatment of metastatic renal cell carcinoma (mRCC) J Clin Oncol, 26: 2008 (abstr 5024)
Szczylik C, Demkow T, Staehler M, et al. Randomised phase II trial of first-line treatment with sorafenib versus interferon in patients with advanced renal cell carcinoma: Final results J Clin Oncol, 25: 18S, 2007 (abstr 5025)
Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med, 356: 125–134, 2007
Yang JC, Haworth L, Sherry RM, et al. A randomised trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med, 349: 427–434, 2003
Escudier B, Pluzanska A, Koralewski P, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet, 370: 2103–2111, 2007
Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med, 356: 2271–2281, 2007
Motzer RJ, Escudier B, Oudard S, et al. Rad001 vs placebo in patients with metastatic renal cell carcinoma (RCC) after progression on VEGFr-TKI therapy: results from a randomised, double-blind, multicenter phase III study. J Clin Oncol, 26: 2008 (abstr 5026)
Knox JJ, Figlin RA, Stadler WM, et al. The Advanced Renal Cell Carcinoma Sorafenib (ARCCS) expanded access trial in North America: Safety and efficacy. J Clin Oncol 25: 18S, 2007 (abstr 5011)
Gore ME, Porta C, Oudard S, et al. Sunitinib in metastatic renal cell carcinoma (mRCC): preliminary assessment of toxicity in an expanded access trial with subpopulation analysis. J Clin Oncol, 25: 18S, 2007 (abstr 5010)
Drabkin HA, Figlin RA, Stadler WM, et al. The Advanced Renal Cell Carcinoma Sorafenib (ARCCS) expanded access trial: safety and efficacy in patients (pts) with prior bevacizumab (BEV) treatment. J Clin Oncol, 25: 18S, 2007 (abstr 5041)
Sablin MP, Bouaita L, Balleyguier C, et al. Sequential use of sorafenib and sunitinib in renal cancer: retrospective analysis in 90 patients. J Clin Oncol, 25: 18S, 2007 (abstr 5038)
Amato RJ, Harris P, Dalton M, et al. A phase II trial of intra-patient dose-escalated sorafenib in patients (pts) with metastatic renal cell cancer (MRCC). J Clin Oncol, 25: 18S, 2007 (abstr 5026)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Berger, A., Hobisch, A. Treatment options in localised and metastatic renal cell carcinoma. memo 1, 167–170 (2008). https://doi.org/10.1007/s12254-008-0055-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12254-008-0055-9