Multimodality treatment paradigms for renal cell carcinoma: surgery versus targeted agents

Area of Science:

• Oncology
• Nephrology
• Translational Research

Background:

• Advanced renal cancer was historically resistant to systemic therapies, with limited benefit from immunotherapy post-nephrectomy.
• Recent molecular insights have led to targeted agents demonstrating significant anti-tumor efficacy and improved progression-free survival in metastatic renal cancer.

Purpose of the Study:

• To review the impact of targeted agents on advanced renal cancer management.
• To discuss the evolving role of surgery (primary tumor extirpation and metastasectomy) in the context of targeted therapies.
• To explore the necessity and optimal timing of surgical interventions within multimodal treatment paradigms.

Main Methods:

• Analysis of preclinical data from basic science and translational research.
• Review of available clinical data on surgical treatment approaches in advanced renal cancer.
• Exploration of multimodal treatment considerations and interdisciplinary decision-making.

Main Results:

• Targeted agents have significantly improved outcomes in advanced and metastatic renal cancer.
• The efficacy of targeted therapies has raised questions regarding the necessity and timing of surgical interventions.
• Preclinical and clinical data suggest a potential role for concomitant surgical treatments alongside systemic agents.

Conclusions:

• Targeted agents have transformed advanced renal cancer treatment, necessitating a re-evaluation of surgical roles.
• Multimodal treatment strategies, integrating targeted therapies with judicious surgical approaches, are crucial for optimizing clinical efficacy.
• Interdisciplinary decision-making is essential for personalized treatment planning in advanced renal cancer.