title: Multidisciplinary management of metastatic renal cell carcinoma in the era of targeted therapies.
abstract: The use of targeted agents to treat metastatic renal cell carcinoma (mRCC) has significantly extended progression-free and overall survival but raises issues relating to the long-term delivery of care and the sustained monitoring of efficacy and toxicities, certain of which have not previously been experienced. In this paper, an expert group of medical oncologists, urologists and oncology nurses and pharmacists review and make informal recommendations on the multidisciplinary management of mRCC in the light of progress made and problems that have arisen. Decentralisation of care, with a shift in emphasis from large to small hospitals and possibly to the community, may offer advantages of cost and convenience. However, the major responsibility for care should continue to lie with clinicians (either medical oncologists or urologists) with extensive experience in mRCC, assisted by specialist nurses, and working in centres with facilities adequate to monitor efficacy and manage toxicities. That said, the extended survival of patients emphasises the importance of compliance and the long-term prevention, detection and management of side effects. Much of this will take place in the community. There is therefore a need for multidisciplinary working to extend beyond specialist centres to include general practitioners, community nurses and pharmacists. Although this paper focuses on mRCC, many of the considerations discussed are also relevant to the management of more common solid tumours in the era of targeted therapy.
authors.affiliation: Institut Gustave Roussy, Villejuif, France. Bernard.Escudier@igr.fr
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Susanne
authors.initials: S
authors.lastname: Osanto
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.forename: John
authors.initials: J
authors.lastname: Wagstaff
authors.forename: Peter
authors.initials: P
authors.lastname: Mulders
authors.forename: Martin
authors.initials: M
authors.lastname: Gore
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.forename: Sergio
authors.initials: S
authors.lastname: Bracarda
authors.forename: Alex
authors.initials: A
authors.lastname: Franklin
authors.forename: Per Hartvig
authors.initials: PH
authors.lastname: Honoré
authors.forename: Alain
authors.initials: A
authors.lastname: Ravaud
authors.forename: Jeanne van
authors.initials: Jv
authors.lastname: Steijn
authors.forename: Zeba
authors.initials: Z
authors.lastname: Aziz
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D016019:Survival Analysis