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Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art
Cedric Lebacle1,2, Aydin Pooli3,4, Thomas Bessede5
1Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. clebacle@mednet.ucla.edu.
Abstract:
Long recognized to confer an extremely poor prognosis, sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a tumor phenotype that is finally beginning to be better understood on the molecular and genetic levels. With an overall incidence that ranges from 1 to 32% depending on associated RCC subtype, the survival of sarcomatoid RCC patients rarely exceeds 2 years. The main reasons for its poor outcome include its aggressive biology, its tendency to present at an advanced or metastatic stage at the time of diagnosis, its high rate of tumor recurrence after nephrectomy, and its limited response to systemic therapies. Molecular pathology studies suggest that sarcomatoid dedifferentiation originates from a focal epithelial-mesenchymal transition (EMT) arising in the carcinomatous component of the tumor. It is hoped that the growing understanding of the molecular biology of sRCC will soon make it possible to adapt treatments based on the identification of actionable tumor alterations. The deliberate inclusion of these patients in the multicenter clinical trials of immune, targeted and combination therapies is a necessary next step in pioneering future treatment strategies.
Insights
Sarcomatoid renal cell carcinoma (sRCC) has a poor prognosis due to aggressive biology and late diagnosis. Understanding its molecular origins, like epithelial-mesenchymal transition (EMT), is key to developing new targeted therapies.
Area of Science:
- Oncology
- Molecular Pathology
Background:
- Sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a rare but aggressive tumor phenotype associated with a poor prognosis.
- Patient survival for sRCC rarely exceeds two years due to aggressive biology, advanced stage at diagnosis, and high recurrence rates.
Purpose of the Study:
- To explore the molecular and genetic underpinnings of sarcomatoid dedifferentiation in renal cell carcinoma.
- To identify potential actionable targets for improved treatment strategies in sRCC.
Main Methods:
- Review of molecular pathology studies investigating sarcomatoid dedifferentiation.
- Analysis of the epithelial-mesenchymal transition (EMT) as a proposed origin of sRCC.
Main Results:
- Sarcomatoid dedifferentiation is hypothesized to arise from a focal epithelial-mesenchymal transition (EMT) within the carcinomatous component.
- Current systemic therapies show limited response in sRCC patients.
Conclusions:
- A deeper understanding of sRCC molecular biology is crucial for developing tailored treatment approaches.
- Inclusion of sRCC patients in clinical trials for immune, targeted, and combination therapies is essential for advancing treatment strategies.
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