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Vol 6, No 4 (2010)
Review paper
Published online: 2010-12-16
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Current options in the management of advanced renal-cell carcinoma — an update

Piotr J. Wysocki, Krzysztof Krzemieniecki, Kazimierz Drosik, Piotr Potemski, Jakub Żołnierek, Maciej Krzakowski
Onkol. Prak. Klin 2010;6(4):143-152.

open access

Vol 6, No 4 (2010)
REVIEW ARTICLES
Published online: 2010-12-16

Abstract

Approximately 30% of patients with renal-cell carcinoma (RCC) have metastases at diagnosis, and in another 30% patients with primarily locally-advanced disease, metastases will occur within 1–2 years. There is no consensus on the optimal management of advanced RCC and complication is due — at least in part — to different outcomes of patients belonging to particular prognostic categories. Palliative surgical interventions — nephrectomy or/and resection of metastases — may play a role in certain clinical situations. Advanced RCC is resistant to cytotoxic and hormonal therapy, whereas the benefit of immunotherapy (interferon a or/and interleukin 2) is modest and cytokines may be helpful solely for a subgroup of patients with favourable prognosis (low risk) and pulmonary metastases only. Current evidence permits administration of immunotherapy as the first-line treatment in selected low-risk patients and of sunitinib for patients with favorable and intermediate prognosis (low and intermediate risk). Bevacizumab with interferon a, despite of prolongation of progression-free survival, failed to prolong overall survival and for pazopanib overall survival data are still pending. Temsirolimus is recommended for the treatment of patients with unfavorable prognosis (high risk). Current evidence indicates sorafenib or pazopanib in the treatment of cytokine-refractory disease. Everolimus is the only agent with proven activity in patients progressing during or after treatment with tyrosine-kinase inhibitors. This review includes interpretation and integration of the available data from prospective clinical trials. Presented opinions do not apply to all patients and each should be adapted individually.

Onkol. Prak. Klin. 2010; 6, 4: 143–152

Abstract

Approximately 30% of patients with renal-cell carcinoma (RCC) have metastases at diagnosis, and in another 30% patients with primarily locally-advanced disease, metastases will occur within 1–2 years. There is no consensus on the optimal management of advanced RCC and complication is due — at least in part — to different outcomes of patients belonging to particular prognostic categories. Palliative surgical interventions — nephrectomy or/and resection of metastases — may play a role in certain clinical situations. Advanced RCC is resistant to cytotoxic and hormonal therapy, whereas the benefit of immunotherapy (interferon a or/and interleukin 2) is modest and cytokines may be helpful solely for a subgroup of patients with favourable prognosis (low risk) and pulmonary metastases only. Current evidence permits administration of immunotherapy as the first-line treatment in selected low-risk patients and of sunitinib for patients with favorable and intermediate prognosis (low and intermediate risk). Bevacizumab with interferon a, despite of prolongation of progression-free survival, failed to prolong overall survival and for pazopanib overall survival data are still pending. Temsirolimus is recommended for the treatment of patients with unfavorable prognosis (high risk). Current evidence indicates sorafenib or pazopanib in the treatment of cytokine-refractory disease. Everolimus is the only agent with proven activity in patients progressing during or after treatment with tyrosine-kinase inhibitors. This review includes interpretation and integration of the available data from prospective clinical trials. Presented opinions do not apply to all patients and each should be adapted individually.

Onkol. Prak. Klin. 2010; 6, 4: 143–152

Get Citation

Keywords

renal-cell carcinoma; advanced stage; palliative treatment; immunotherapy; molecular targeted therapy

About this article
Title

Current options in the management of advanced renal-cell carcinoma — an update

Journal

Oncology in Clinical Practice

Issue

Vol 6, No 4 (2010)

Article type

Review paper

Pages

143-152

Published online

2010-12-16

Bibliographic record

Onkol. Prak. Klin 2010;6(4):143-152.

Keywords

renal-cell carcinoma
advanced stage
palliative treatment
immunotherapy
molecular targeted therapy

Authors

Piotr J. Wysocki
Krzysztof Krzemieniecki
Kazimierz Drosik
Piotr Potemski
Jakub Żołnierek
Maciej Krzakowski

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