Is there a role for presurgical therapy for renal cell carcinoma?

Area of Science:

• Oncology
• Nephrology
• Surgical Oncology

Background:

• Molecular targeted therapies, including anti-VEGF antibodies, tyrosine kinase inhibitors, and mTOR inhibitors, are increasingly used for advanced solid tumors.
• These novel agents demonstrate antitumor activity and a manageable toxicity profile, leading to their use in locally advanced or metastatic renal cell carcinoma (RCC).
• Lessons from the immunotherapy era inform the evaluation of surgical roles alongside neoadjuvant therapies in RCC management.

Purpose of the Study:

• To review the current role of surgery in patients with locally advanced and metastatic renal cell carcinoma (RCC).
• To evaluate the potential benefits and pitfalls of presurgical (neoadjuvant) therapy with molecular targeted agents in RCC.
• To assess the implications of neoadjuvant targeted therapy in the context of metastatic RCC.

Main Methods:

• Literature review of studies on targeted therapies and surgery in renal cell carcinoma.
• Analysis of clinical trial data and case reports regarding neoadjuvant molecular agents.
• Comparative assessment of outcomes in patients receiving neoadjuvant therapy versus standard surgical care.

Main Results:

• Targeted therapies are being explored as neoadjuvant treatments for locally advanced and metastatic RCC.
• Potential benefits include tumor downstaging and improved surgical resection rates.
• Potential pitfalls involve managing treatment-related toxicities and understanding resistance mechanisms.

Conclusions:

• Presurgical targeted therapy may offer new avenues for managing advanced RCC.
• Careful patient selection and multidisciplinary approaches are crucial for optimizing outcomes.
• Further research is needed to establish definitive roles for neoadjuvant targeted agents in RCC treatment paradigms.