Skip to main content

Advertisement

Log in

Treatment options in localised and metastatic renal cell carcinoma

  • Short review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

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

    Article  PubMed  Google Scholar 

  • Chow WH, Devesa SS, Warren JL, et al. Rising incidence of renal cell cancer in the United States. JAMA, 281: 1628–1631, 1999

    Article  PubMed  CAS  Google Scholar 

  • Wszolek MF, Wotkowicz C, Libertino JA. Surgical management of large renal tumours. Nat Clin Pract Urol, 5: 35–46, 2008

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol, 89: 37–42, 1963

    PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Motzer RJ, Russo P. Systemic therapy for renal cell carcinoma. J Urol, 163: 408–417, 2000

    Article  PubMed  CAS  Google Scholar 

  • Coppin C, Porzsolt F, Awa A, et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev. 2005 Jan 25: CD001425, 2005

    Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Chow LQ, Eckhardt SG Sunitinib: From rational design to clinical efficacy. J Clin Oncol, 25: 884–896, 2007

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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)

    Google Scholar 

  • Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med, 356: 125–134, 2007

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • 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)

    Google Scholar 

  • 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)

    Google Scholar 

  • 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)

    Google Scholar 

  • 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)

    Google Scholar 

  • 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)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. P. Berger.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-008-0055-9

Keywords

Navigation