[Advanced renal carcinomas with special situations. How to treat them?]

Area of Science:

• Oncology
• Medical Research

Background:

• Advanced or metastatic renal carcinoma treatment faced limitations before recent therapeutic advancements.
• Targeted therapies like VEGF-R inhibitors (sorafenib, sunitinib, bevacizumab) and mTOR inhibitors (temsirolimus, everolimus) have improved patient prognosis and quality of life.

Purpose of the Study:

• To evaluate the efficacy and safety of novel targeted therapies in advanced renal carcinoma patients with distinct characteristics often excluded from pivotal trials.
• To highlight the need for further clinical investigations in specific patient subgroups.

Main Methods:

• Review of existing clinical trial data and real-world practice observations.
• Analysis of treatment outcomes in patients with poor performance status, elderly patients, renal dysfunction, cerebral metastases, and non-clear cell subtypes.
• Assessment of treatment tolerance and survival benefits in these specific populations.

Main Results:

• While tolerance to VEGF-R and mTOR inhibitors is comparable to the general population in geriatric patients, those with poor performance status, central neurological metastases, or specific subtypes (papillary, chromophobe), confirming progression-free and overall survival increases is challenging.
• VEGF receptor inhibitors may require cautious initiation at reduced doses in patients with renal insufficiency, with subsequent dose adjustments based on tolerance.
• Limited data exists for these specific populations, often stemming from small, retrospective, or non-randomized studies.

Conclusions:

• Current evidence for advanced renal carcinoma patients with unique characteristics is limited, necessitating further robust clinical trials.
• Careful evaluation of potential benefits versus toxicities is crucial before initiating treatment in these diverse patient groups.
• Clinical trials are essential to establish definitive treatment guidelines for specific populations in advanced renal carcinoma.