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Renal Cancer pp 411-435 | Cite as

Unified Approaches to Surgery and Systemic Therapy for Renal Cell Carcinoma

  • Alejandro Abello
  • Patrick A. KenneyEmail author
Chapter

Abstract

Renal cell carcinoma (RCC) remains a significant cause of mortality among genitourinary malignancies. It will be essential to rationally integrate surgery and systemic therapy to improve outcomes in RCC. Despite substantial efforts to date and a newly FDA-approved agent, there remains no clear role for adjuvant therapy following nephrectomy for clinically localized disease. Several studies aimed to identify effective agents in the adjuvant setting, including mTOR and tyrosine kinase inhibitors, vaccines, as well as a monoclonal antibody against CA IX. None have shown improvement in overall survival. Sunitinib has had mixed results and may improve disease-free survival in a high-risk subset. For locally advanced disease, it has been proposed that neoadjuvant therapy may make unresectable disease resectable, enable partial nephrectomy, or shrink venous tumor thrombus. These theoretical goals remain in need of further study. For patients with metastatic RCC, the correct paradigm remains to be elucidated. In particular, the role of cytoreductive nephrectomy in the modern era is an active area of debate and research.

Keywords

Renal cell carcinoma Adjuvant therapy Neoadjuvant therapy Cytoreductive nephrectomy Immunotherapy Targeted therapy Angiogenesis inhibitor Tyrosine kinase inhibitor 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Urology/Yale School of MedicineYale New Haven HospitalNew HavenUSA

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