Renal cell carcinoma: An update for the practicing urologist

Area of Science:

• Oncology
• Nephrology

Background:

• Systemic therapy for metastatic renal cell carcinoma (mRCC) has advanced, with vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors as standard care.
• Clinical trials are crucial for refining mRCC treatment strategies.

Purpose of the Study:

• To review the current status of clinical trials in metastatic renal cell carcinoma.
• To examine ongoing and recently completed studies evaluating novel therapeutic approaches.

Main Methods:

• Review of recently completed and ongoing clinical trials in mRCC.
• Analysis of data regarding localized disease, cytoreductive nephrectomy, and first-line management.

Main Results:

• Observation is standard post-localized resection, but trials assessing VEGF- and mTOR-therapies are active.
• Retrospective data support cytoreductive nephrectomy with targeted agents, but prospective data are pending.
• First-line mRCC management may be significantly altered by ongoing trials of vaccines, immune checkpoint inhibitors, and novel targeted agents.

Conclusions:

• Prospective studies in the coming years are critical for defining the roles of adjuvant therapy and cytoreductive nephrectomy in mRCC.
• The current first-line treatment paradigm for mRCC is expected to evolve significantly.