title: Management of poor-risk metastatic renal cell carcinoma: current approaches, the role of temsirolimus and future directions.
abstract: Targeted therapies have substantially improved outcomes in metastatic renal cell carcinoma (mRCC). As expected, poor-risk patients have the worst outcomes. Temsirolimus is currently the only agent licensed for treatment of poor-risk mRCC patients. It is associated with meaningful improvements in survival and quality of life, highlighting the importance of correctly stratifying risk in mRCC patients so they receive optimal treatment. Currently, data for other targeted therapies in poor-risk patients are relatively sparse. Optimizing outcomes in these patients is the subject of ongoing research, including studies of biomarkers and studies to elucidate the role of nephrectomy and neoadjuvant targeted therapy in poor-risk mRCC patients. The impacts of novel combinations including temsirolimus have also been explored to further improve outcomes.
authors.affiliation: Department of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.affiliation: Department of Medical Oncology, Medical School & Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tortora
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: James M G
authors.initials: JM
authors.lastname: Larkin
authors.affiliation: Texas Oncology, PA, Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA.|Texas AM Health Science Center College of Medicine, Dallas, TX, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hutson
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D002986:Clinical Trials as Topic; D019468:Disease Management; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D018570:Risk Assessment; D020123:Sirolimus / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D047428:Protein Kinase Inhibitors; C401859:temsirolimus; D020123:Sirolimus
keywords: RCC; biomarkers; metastatic renal cell carcinoma; nephrectomy; poor prognostic risk; temsirolimus