How Targeted Therapy Influence Renal Surgery for Renal Cell Carcinoma
| Autor: | Francesco Esperto, Michele Marchioni, Francesco Greco, Rocco Papalia, Roberto M Scarpa, Luigi Schips |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Oncology
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Clinical Biochemistry 030232 urology & nephrology Antineoplastic Agents Nephrectomy Systemic therapy Tyrosine-kinase inhibitor Targeted therapy 03 medical and health sciences 0302 clinical medicine Renal cell carcinoma Internal medicine Drug Discovery medicine Humans Molecular Targeted Therapy Kidney surgery Carcinoma Renal Cell Randomized Controlled Trials as Topic Pharmacology business.industry medicine.disease Kidney Neoplasms Neoadjuvant Therapy Clinical trial Chemotherapy Adjuvant 030220 oncology & carcinogenesis Cytokines Molecular Medicine Immunotherapy business Adjuvant Tyrosine kinase |
| Zdroj: | Current Drug Targets. 21:1550-1557 |
| ISSN: | 1389-4501 |
| DOI: | 10.2174/1389450121666200704150933 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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