Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached...Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival(ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with m RCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it's based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with longterm survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.展开更多
Renal cell carcinoma(RCC)is regarded as one of the most refractory malignancies.A further study of the molecular mechanism of RCC formation has led to a series of successful examples for treatment of patients with adv...Renal cell carcinoma(RCC)is regarded as one of the most refractory malignancies.A further study of the molecular mechanism of RCC formation has led to a series of successful examples for treatment of patients with advanced RCC.Over the past 20 years,a nonspecific immunotherapy,with cytokines,has been employed as the gold standard for therapy of metastatic RCC.However,with scientific development and clinical testing of new drugs,targeted molecular cancer therapy has become a focus of interest.At the same time,with a better understanding of RCC, the treatment method has converged on anti-vascular endothelial growth factor(VEGF)and related molecular-targeted pathways. A large amount of research and numerous clinical trials have demonstrated the clinical efficacy of the targeted molecular therapies in patients with metastatic RCC.For example sorafenib and sunitinib were approved,in 2005 and 2006 respectively,by the U.S.FDA for treating advanced RCC.In this report,issues such as the importance of VEGF in RCC and the studies of bevacizumab, sunitinib and sorafenib in treating metastatic RCC etc.,are reviewed.展开更多
文摘Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival(ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with m RCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it's based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with longterm survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.
文摘Renal cell carcinoma(RCC)is regarded as one of the most refractory malignancies.A further study of the molecular mechanism of RCC formation has led to a series of successful examples for treatment of patients with advanced RCC.Over the past 20 years,a nonspecific immunotherapy,with cytokines,has been employed as the gold standard for therapy of metastatic RCC.However,with scientific development and clinical testing of new drugs,targeted molecular cancer therapy has become a focus of interest.At the same time,with a better understanding of RCC, the treatment method has converged on anti-vascular endothelial growth factor(VEGF)and related molecular-targeted pathways. A large amount of research and numerous clinical trials have demonstrated the clinical efficacy of the targeted molecular therapies in patients with metastatic RCC.For example sorafenib and sunitinib were approved,in 2005 and 2006 respectively,by the U.S.FDA for treating advanced RCC.In this report,issues such as the importance of VEGF in RCC and the studies of bevacizumab, sunitinib and sorafenib in treating metastatic RCC etc.,are reviewed.
