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The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors

Nicholas G Cost1, Laura-Maria Krabbe, Aditya Bagrodia

  • 1Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.

Current Opinion in Urology
|July 12, 2013
PubMed
Abstract

Insights

Presurgical targeted molecular therapies (TMTs) are feasible and safe before nephron-sparing surgery (NSS) for renal cell carcinoma. While effective in selected cases, further research is needed to confirm optimal use and outcomes.

Area of Science:

  • Oncology
  • Nephrology
  • Pharmacology

Background:

  • Renal cell carcinoma (RCC) management often involves nephron-sparing surgery (NSS).
  • Targeted molecular therapies (TMTs) have shown efficacy in advanced RCC.
  • The role of presurgical TMTs in optimizing NSS for specific RCC cases is emerging.

Purpose of the Study:

  • To review the current literature on the feasibility, safety, and outcomes of presurgical TMTs before NSS in RCC patients.
  • To evaluate the potential benefits of TMTs in patients with tumors unsuitable for standard NSS but with imperative indications for kidney preservation.

Main Methods:

  • Systematic literature review of studies investigating presurgical TMTs for RCC.
  • Analysis of data on TMT efficacy, safety, and surgical outcomes.
  • Assessment of complication rates and tolerance of TMTs in the context of NSS.

Main Results:

  • Presurgical TMTs are effective and well-tolerated for unresectable or bulky tumors requiring NSS, especially in patients with a solitary kidney, bilateral tumors, or CKD.
  • Surgical complication rates are low when TMTs are appropriately timed around surgery (withheld per half-life).
  • TMTs demonstrate feasibility and good tolerance in selected RCC patients undergoing NSS.

Conclusions:

  • Presurgical TMTs can be a well-tolerated, effective, and feasible option for selected RCC patients undergoing NSS.
  • The use of TMTs before NSS is currently considered experimental.
  • Further research is essential to establish definitive indications, optimal timing, and long-term outcomes for this therapeutic approach.

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