title: Optimizing treatment for patients with metastatic renal cell carcinoma in the Central and Eastern European region.
abstract: BACKGROUND
  Belarus, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Republic of Moldova, Romania, Russian Federation, Serbia, Slovakia, Slovenia and the Ukraine represent a collection of Central and Eastern European (CEE) countries in which the epidemiology and treatment of cancer varies greatly between and within countries. Current challenges include non-adherence to current treatment guidelines, restrictions in access and reimbursement for new therapies, and a lack of basic oncology programs. Metastatic renal cell carcinoma (mRCC) is a malignancy with historically poor prognosis. In CEE countries, the incidence and mortality rates of mRCC are among the highest in the world. Fortunately, mRCC represents a cancer for which a number of new targeted therapies have recently demonstrated benefit, resulting in new evidence-based treatment guidelines. Incorporating these mRCC treatment recommendations into the routine care of patients with mRCC in CEE countries would represent a major step forward for cancer care in this region.
  
  
  METHODS
  This review discusses the unique challenges faced by the aforementioned Eastern European countries in the treatment of metastatic renal cell cancer, in an attempt to assist health-care providers in providing the best care possible for their European patients.
  
  
  CONCLUSIONS
  Despite a wealth of clinical trial data supporting the use of targeted therapies for first-line treatment of mRCC, cytokine-based immunotherapy is still used in some of these European countries. With implementation and adherence to existing guidelines, treatment can be clinically and economically optimized in patients with mRCC from this region.
authors.affiliation: Department of Oncology, University Hospital Split, Split, Spinciceva 1, 21000 Split, Croatia. eduard.vrdoljak@st.htnet.hr
authors.forename: Eduard
authors.initials: E
authors.lastname: Vrdoljak
authors.forename: Tudor
authors.initials: T
authors.lastname: Ciuleanu
authors.forename: Galina
authors.initials: G
authors.lastname: Kharkevich
authors.forename: Jozef
authors.initials: J
authors.lastname: Mardiak
authors.forename: Michal
authors.initials: M
authors.lastname: Mego
authors.forename: Peeter
authors.initials: P
authors.lastname: Padrik
authors.forename: Luboš
authors.initials: L
authors.lastname: Petruželka
authors.forename: Gunta
authors.initials: G
authors.lastname: Purkalne
authors.forename: Yaroslav
authors.initials: Y
authors.lastname: Shparyk
authors.forename: Breda
authors.initials: B
authors.lastname: Skrbinc
authors.forename: Cezary
authors.initials: C
authors.lastname: Szczylik
authors.forename: Laszlo
authors.initials: L
authors.lastname: Torday
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D003365:Costs and Cost Analysis; D005060:Europe; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D009362:Neoplasm Metastasis; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents