In this article, we review de state of the art on the management of renal cell carcinoma (RCC) and provide recommendations on diagnosis and treatment. Recent advances in molecular biology have allowed the subclassification of renal tumours into different histologic variants and may help to identify future prognostic and predictive factors. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. No adjuvant therapy has demonstrated a clear benefit in overall survival. Considering the whole population of patients with advanced disease, the combination of axitinib with either pembrolizumab or avelumab increase response rate and progression-free survival, compared to sunitinib, but a longer overall survival has only been demonstrated so far with the pembrolizumab combo. For patients with IMDC intermediate and poor prognosis, nephrectomy should not be considered mandatory. In this subpopulation, the combination of ipilimumab and nivolumab has also demonstrated a superior response rate and overall survival vs. sunitinib. In patients progressing to one or two antiangiogenic tyrosine-kinase inhibitors, both nivolumab and cabozantinib in monotherapy have shown benefit in overall survival compared to everolimus. Although no clear sequence can be recommended, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in patients with metastatic RCC.
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2020 Jan 28 [Epub ahead of print]
M Lázaro, B P Valderrama, C Suárez, G de-Velasco, C Beato, I Chirivella, A González-Del-Alba, N Laínez, M J Méndez-Vidal, J A Arranz
Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor 341, 36213, Vigo, Pontevedra, Spain. ., Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain., Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain., Medical Oncology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain., Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain., Medical Oncology Department, Hospital Clínico, Universidad de Valencia, Valencia, Spain., Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain., Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain., Medical Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Córdoba, Spain., Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.