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Complementary roles of surgery and systemic treatment in clear cell renal cell carcinoma

Standard-of-care management of renal cell carcinoma (RCC) indisputably relies on surgery for low-risk localized tumours and systemic treatment for poor-prognosis metastatic disease, but a grey area remains, encompassing high-risk localized tumours and patients with metastatic disease with a good-to-...

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Main Authors: Ingels, Alexandre (Author) , Campi, Riccardo (Author) , Capitanio, Umberto (Author) , Amparore, Daniele (Author) , Bertolo, Riccardo (Author) , Carbonara, Umberto (Author) , Erdem, Selcuk (Author) , Kara, Önder (Author) , Klatte, Tobias (Author) , Kriegmair, Maximilian (Author) , Marchioni, Michele (Author) , Mir, Maria C. (Author) , Ouzaïd, Idir (Author) , Pavan, Nicola (Author) , Pecoraro, Angela (Author) , Roussel, Eduard (Author) , de la Taille, Alexandre (Author)
Format: Article (Journal)
Language:English
Published: 11 May 2022
In: Nature reviews. Urology
Year: 2022, Volume: 19, Issue: 7, Pages: 391-418
ISSN:1759-4820
DOI:10.1038/s41585-022-00592-3
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1038/s41585-022-00592-3
Verlag, lizenzpflichtig, Volltext: http://www.nature.com/articles/s41585-022-00592-3
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Author Notes:Alexandre Ingels, Riccardo Campi, Umberto Capitanio, Daniele Amparore, Riccardo Bertolo, Umberto Carbonara, Selcuk Erdem, Önder Kara, Tobias Klatte, Maximilian C. Kriegmair, Michele Marchioni, Maria C. Mir, Idir Ouzaïd, Nicola Pavan, Angela Pecoraro, Eduard Roussel, Alexandre de la Taille
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Summary:Standard-of-care management of renal cell carcinoma (RCC) indisputably relies on surgery for low-risk localized tumours and systemic treatment for poor-prognosis metastatic disease, but a grey area remains, encompassing high-risk localized tumours and patients with metastatic disease with a good-to-intermediate prognosis. Over the past few years, results of major practice-changing trials for the management of metastatic RCC have completely transformed the therapeutic options for this disease. Treatments targeting vascular endothelial growth factor (VEGF) have been the mainstay of therapy for metastatic RCC in the past decade, but the advent of immune checkpoint inhibitors has revolutionized the therapeutic landscape in the metastatic setting. Results from several pivotal trials have shown a substantial benefit from the combination of VEGF-directed therapy and immune checkpoint inhibition, raising new hopes for the treatment of high-risk localized RCC. The potential of these therapeutics to facilitate the surgical extirpation of the tumour in the neoadjuvant setting or to improve disease-free survival in the adjuvant setting has been investigated. The role of surgery for metastatic RCC has been redefined, with results of large trials bringing into question the paradigm of upfront cytoreductive nephrectomy, inherited from the era of cytokine therapy, when initial extirpation of the primary tumour did show clinical benefits. The potential benefits and risks of deferred surgery for residual primary tumours or metastases after partial response to checkpoint inhibitor treatment are also gaining interest, considering the long-lasting effects of these new drugs, which encourages the complete removal of residual masses.
Item Description:Gesehen am 28.11.2023
Physical Description:Online Resource
ISSN:1759-4820
DOI:10.1038/s41585-022-00592-3

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