Multimodality treatment paradigms for renal cell carcinoma: surgery versus targeted agents.
For decades, advanced renal cancer was almost resistant to systemic therapy. Only a few patients with metastatic disease derived clinical benefit from immunotherapy after nephrectomy. Recent advances in understanding the molecular biology of advanced and metastatic renal cancer led to the development of several targeted agents that showed impressive anti-tumor efficacy and prolongation of progression-free survival. The integration of these drugs into clinical practice did not only revolutionize the management of renal cancer, but also created controversy about the necessity, patient selection for and timing of the extirpation of the primary tumor, as well as metastasectomy. Data from ongoing preclinical investigations, including basic science and translational research, are presented and carried forward into multimodal considerations to optimize clinical efficacy of concomitant surgical treatments in the era of targeted agents. In addition to these analyses, this article highlights available clinical data regarding the disputable importance of surgical treatment approaches and explores the need of multimodality treatment paradigms within interdisciplinary decision making.
Köpke
Thomas
T
Department of Urology, University of Münster, Münster, Germany.
Bierer
Stefan
S
Wülfing
Christian
C
Tiemann
Arne
A
Hertle
Lothar
L
Herrmann
Edwin
E
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016503:Drug Delivery Systems; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000628:therapy*; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods; D018579:Patient Selection
D000970:Antineoplastic Agents