Current Algorithms and Prognostic Factors in the Treatment of Metastatic Renal Cell Carcinoma |
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| Institution: | 1. Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China;2. Engineering College, Jiangxi Agriculture University, Nanchang 330045, PR China;3. Key Laboratory for Molecular Enzymology and Engineering of Ministry of Education, Jilin University, Changchun 130012, PR China;4. University of Chinese Academy of Sciences, Beijing 100049, PR China;1. Department of Pharmaceutics, College of Pharmaceutical Sciences, Soochow University, Suzhou 215123, China;2. Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;3. School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China;1. Department of Gynecology and Obstetrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China;2. Department of Brain Cognition Computing Lab, University of Kent, Kent CT2 7NZ, UK;1. Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY;3. Department of Pathology, North Shore Health System at Lenox Hill Hospital, New York, NY;4. Department of Surgery, Division on Urology, The Anschutz Cancer Center, University of Colorado Health Sciences Center, Aurora, CO |
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| Abstract: | Metastatic renal cell carcinoma (RCC) is highly resistant to chemotherapy but responds modestly to cytokine therapy. The prognosis for longterm survival is poor. Approximately 10% of patients who present with metastatic disease or relapse after nephrectomy are alive at 5 years. Identification of prognostic or predictive factors for individual patient outcomes is necessary in order to develop tailored treatments that reduce the risk of relapse and enhance the chance of successful management. The relationship between pretreatment clinical features and survival has been evaluated in studies leading to the creation of a Memorial Sloan- Kettering Cancer Center (MSKCC) risk model. Additionally, the cloning of the von Hippel—Lindau tumor suppressor gene, and the elucidation of its role in upregulating growth factors associated with angiogenesis, has provided insight into RCC biology and defined a series of targets for novel therapeutic agents. These targeted agents, including sunitinib, sorafenib, temsirolimus, everolimus, and bevacizumab plus interferon-α, have shown benefit in phase III trials in first- and second-line therapy. Analysis of the data from these trials and use of prognostic models have resulted in a new paradigm for the treatment of metastatic RCC. Herein, we review these targeted agents, the MSKCC risk model, and the new paradigm for treatment of metastatic RCC. |
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