Treatment of kidney cancer

Abstract

Introduction. Renal cell carcinoma is the most common type of kidney cancer in adults. It accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. In recent years, several approaches of active and passive immunotherapy have been studied extensively in clinical trials of patients with RCC. Recent advances in molecular biology have led to the development of novel agents for the treatment. Aim of the study. To describe the contemporary standard of treatment for kidney cancer, and their comparison with the classical methods of treatment, the current standard of care, the role of prognostic criteria, such as those from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria. Materials and methods.. The study presents the magazine of literature (Medline, Scopus, PubMed, School google, etc.) Results. Radical nephrectomy remains the mainstay of initial treatment for patients with renal tumours without evidence of metastatic disease. The goal of partial nephrectomy is the complete elimination of the primary tumor, while maintaining the highest possible amount of parenchymal renal health. Partial nephrectomy is indicated for the patient with T1 tumors (according to TNM staging for international cancer control) and a normal contralateral kidney. In patients with unresectable and/or metastatic cancers, tumor embolization, external-beam radiation therapy, and nephrectomy can aid in the palliation of symptoms caused by the primary tumor or related ectopic hormone or cytokine production. The drugs used in chemotherapy are floxuridine, 5-fluorouracil and vinblastine. But unfortunately, these drugs are proven resistant to renal cell carcinoma. In contrast with chemotherapy, targeted treatments attack specific molecules and cell mechanisms which are required for carcinogenesis and tumor growth. This specific targeting helps to spare healthy tissues and reduce side effects. Targeted cancer therapies may be more effective than current treatments and less injurious to normal cells. Research has revealed that addition of these targeted treatments to immunotherapy, or using them as a substitute of immunotherapy, nearly doubles the time duration so as to stop cancer growth. Systemic therapy in metastatic renal cell carcinoma includes Sunitinib and pazopanib that are approved treatments in first-line therapy for patients with favorable- or intermediaterisk clear cell RCC. Temsirolimus has proven benefit over interferon-alfa in patients with nonclear cell RCC. Systemic therapy has demonstrated only limited effectiveness. New agents including the small molecule targeted inhibitors like sorafenib, bevacizumab, axitinib and the monoclonal antibody bevacizumab have shown anti-tumour activity in randomised clinical trials and have become the standard of care for most patients. Conclusions. For patients with surgically resectable RCC, the standard of care is surgical excision by either partial or radical nephrectomy with a curative intent. By contrast, those withinoperable or metastatic RCC typically undergo systemic treatment with targeted agents and/or immune checkpoint inhibitors.