Title:How Targeted Therapy Influence Renal Surgery for Renal Cell Carcinoma
Volume: 21
Issue: 15
Author(s): Francesco Greco*, Michele Marchioni, Francesco Esperto, Rocco Papalia, Luigi Schips and Roberto M. Scarpa
Affiliation:
- Department of Urology, Humanitas Gavazzeni, Bergamo,Italy
Keywords:
Renal tumor, systemic therapies, immunotherapies, kidney surgery, mRCC, CARMENA and SURTIME.
Abstract: Between the end of 2005 and the beginning of 2006, several new target therapies have been
introduced for the treatment of renal cell carcinoma. In this review, we aimed to explore and summarize
the main findings of the use of systemic treatment and its effect on surgery in patients with renal
cell carcinoma. We identified three different settings: neoadjuvant and adjuvant settings as well as the
association of systemic therapy with surgery in the metastatic renal cell carcinoma patients. Neoadjuvant
target therapy with tyrosine kinase inhibitor may facilitate the tumor resection and reduce the
overall tumor diameter and its complexity. However, most of the evidence is from small phase I or II
clinical trials and results are often conflicting without determining a relevant change in the main parameters
investigated, such as tumor complexity. In the adjuvant setting, results from pivotal trials investigating
the use of tyrosine kinase inhibitors for patients with non-metastatic RCC treated with surgery
discourage this practice. Indeed, most of the evidence from single clinical trials and pooled results
from meta-analysis failed to find a survival advantage with the use of adjuvant systemic treatment.
To date, an improvement of clinical outcomes after systemic targeted therapies could be only
found in the setting of cytoreductive nephrectomy. However, the CARMENA and SURTIME trials
recently confirmed the evidence against a surgical treatment in patients with mRCC and poor prognosis.
In the near future, significant changes may be introduced by the use of immunotherapies.
