CURRENT MANAGEMENT OF METASTATIC RENAL CELL CARCINOMA
Ahmed Moustafa Mahmoud Nafie;
Abstract
enal cell carcinoma represents 2-3% of all cancers. Approximately one third of all newly diagnosed RCC patients present with synchronous metastatic disease and additional 20%-40% with localized disease at diagnosis will develop metastasis.
RCC comprises different histologic types resulting from different genetic mutations. Histologically; RCC is subdivided into clear cell and non-clear cell RCC where clear cell type is more common so attracting more attention regarding therapeutic agents.
Non-clear cell types have different response than that of clear cell type towards targeted therapy.Recent researches are still searching for the appropriate treatment for these histologic subtypes.
The identification of prognostic factors for mRCC represents an era of expanding interest aiming for reaching clinical prognostic models capable of expecting the survival years and judge the patients response to recent therapies.
According to recent researches applied on large number of patients; the Memorial sloan kettering cancer center (MSKCC) is the most commonly used clinical prognostic model validated recently by Cleveland clinical group.
The role of surgery in metastatic RCC is still of importance despite the obvious improvement in systemic therapy especially targeted therapy. The role of surgery is divided into Nephrectomyand metastasectomy.
Nephrectomy; mainly cytoreductive (debulking) nephrectomy is associated with improvement in quality of life, survival years and progression free interval.
Consolidative nephrectomy following immunotherapy was examined in several trials, which proved that cytoreductive nephrectomy has better impact on quality of life, survival years and progression free interval.Trials are still in progress to find new role for consolidative nephrectomy in the era of targeted therapy.
Metastasectomy proved to have great impact on quality of life, and survival years.Metastasis is divided into synchronous and metachronus metastasis, where metachronus metastasis has better prognosis.The most common sites of metastasis are lung, bone, liver brain, with best prognosis for metastasis in the lung and the worst is that affects nervous system.
Intervention depends upon site of metastasis.Metastasis in vertebral column must be excised as it affects mobility. Irradiation is found to have a role in metastasis to brain.
Systemic therapy for metastatic RCC is divided into immunotherapy and targeted therapy. Immunotherapy depends on the immunogenic nature of RCC suggested by occasional spontaneous regression of RCC as well as detection of tumor in filtrating lymphocytes in RCC tissue. Immunotherapy is divided into cytokine therapy and cellular immunotherapy.
Cytokine therapy includes interferon- and interlukin-2 which were the first line of treatment in mRCC cases with Good prognosis. Now their role is less effective especially with the improvement of targeted therapy but still used in combination with some agents of targeted therapy.
Cellular immunotherapy: despite limited clinical efficacy of most therapeutic vaccines in metastatic RCC which is still under trials there is interest in the use of vaccines that have less toxicity than other therapies.The discovery of new tumor
RCC comprises different histologic types resulting from different genetic mutations. Histologically; RCC is subdivided into clear cell and non-clear cell RCC where clear cell type is more common so attracting more attention regarding therapeutic agents.
Non-clear cell types have different response than that of clear cell type towards targeted therapy.Recent researches are still searching for the appropriate treatment for these histologic subtypes.
The identification of prognostic factors for mRCC represents an era of expanding interest aiming for reaching clinical prognostic models capable of expecting the survival years and judge the patients response to recent therapies.
According to recent researches applied on large number of patients; the Memorial sloan kettering cancer center (MSKCC) is the most commonly used clinical prognostic model validated recently by Cleveland clinical group.
The role of surgery in metastatic RCC is still of importance despite the obvious improvement in systemic therapy especially targeted therapy. The role of surgery is divided into Nephrectomyand metastasectomy.
Nephrectomy; mainly cytoreductive (debulking) nephrectomy is associated with improvement in quality of life, survival years and progression free interval.
Consolidative nephrectomy following immunotherapy was examined in several trials, which proved that cytoreductive nephrectomy has better impact on quality of life, survival years and progression free interval.Trials are still in progress to find new role for consolidative nephrectomy in the era of targeted therapy.
Metastasectomy proved to have great impact on quality of life, and survival years.Metastasis is divided into synchronous and metachronus metastasis, where metachronus metastasis has better prognosis.The most common sites of metastasis are lung, bone, liver brain, with best prognosis for metastasis in the lung and the worst is that affects nervous system.
Intervention depends upon site of metastasis.Metastasis in vertebral column must be excised as it affects mobility. Irradiation is found to have a role in metastasis to brain.
Systemic therapy for metastatic RCC is divided into immunotherapy and targeted therapy. Immunotherapy depends on the immunogenic nature of RCC suggested by occasional spontaneous regression of RCC as well as detection of tumor in filtrating lymphocytes in RCC tissue. Immunotherapy is divided into cytokine therapy and cellular immunotherapy.
Cytokine therapy includes interferon- and interlukin-2 which were the first line of treatment in mRCC cases with Good prognosis. Now their role is less effective especially with the improvement of targeted therapy but still used in combination with some agents of targeted therapy.
Cellular immunotherapy: despite limited clinical efficacy of most therapeutic vaccines in metastatic RCC which is still under trials there is interest in the use of vaccines that have less toxicity than other therapies.The discovery of new tumor
Other data
| Title | CURRENT MANAGEMENT OF METASTATIC RENAL CELL CARCINOMA | Other Titles | العـــلاج الحالـــي لأورام الخلايــــا الكلويــة المنتشـــره | Authors | Ahmed Moustafa Mahmoud Nafie | Issue Date | 2014 |
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