Treatment strategies for advanced renal cell carcinoma: A new paradigm for surgical treatment

International Journal of Urology : Official Journal of the Japanese Urological Association
Yoshihiko Tomita

Abstract

The induction of targeted drugs for the treatment of metastatic renal cell carcinoma has changed the treatment strategy for systemic therapy. Surgical treatment for metastatic renal cell carcinoma should also be reconsidered in the light of the effect of targeted drugs. The clinical benefit of cytoreductive nephrectomy for cases of metastatic renal cell carcinoma was proved in randomized trials in the cytokine era. However, at present, there has not been level 1 evidence for this in the targeted therapy era. Patients with better performance status and without poor risk factors tend to benefit from cytoreductive nephrectomy. Two ongoing large-scale randomized studies might shed light on this issue. One of the remarkable differences in the efficacy between cytokines and targeted drugs, particularly tyrosine kinase inhibitors, is the reduction in the size of the primary tumors by tyrosine kinase inhibitors, including sunitinib and axitinib. Initial experiences with targeted therapy suggest that the neoadjuvant setting of tyrosine kinase inhibitors could be a viable option when the primary tumor shows local invasion and/or is unresectable. The present study does not support the routine neoadjuvant use of sunitinib because of the po...Continue Reading

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Citations

Mar 3, 2020·Japanese Journal of Clinical Oncology·Junichi InokuchiYoshihiko Tomita
Jan 3, 2021·World Journal of Urology·Alberto MartiniUmberto Capitanio
Dec 15, 2020·International Journal of Urology : Official Journal of the Japanese Urological Association·Shingo HatakeyamaChikara Ohyama

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