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Ronan Flippot1, Lisa Derosa1, Laurence Albiges1

  • 1Département de médecine oncologique, Gustave-Roussy, Villejuif, France.

Bulletin Du Cancer
|January 1, 2019
PubMed
Summary

Brain metastases from renal cell carcinoma (RCC) have a poor prognosis. Early identification and dedicated clinical trials are crucial for improving treatment outcomes for these patients.

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Area of Science:

  • Oncology
  • Neurosurgery
  • Immunology

Background:

  • Brain metastases from renal cell carcinoma (RCC) present a significant clinical challenge with a dismal prognosis.
  • While the blood-brain barrier may be disrupted, it doesn't fully explain treatment resistance in these metastases.
  • RCC brain metastases often exhibit molecular alterations, high lymphocytic infiltration, and PD-1/PD-L1 immune checkpoint expression.

Purpose of the Study:

  • To review the current understanding of brain metastases in renal cell carcinoma.
  • To highlight the unmet need in managing this condition.
  • To discuss potential avenues for improving patient outcomes.

Main Methods:

  • Literature review of studies on renal cell carcinoma brain metastases.
  • Analysis of biological characteristics, prognostic factors, and current treatment strategies.
Keywords:
Brain metastasesCarcinome à cellulesImmune checkpointImmunothérapieMolecular targetedMétastases cérébralesRadiation therapyRadiothérapieRenal cell carcinomaThérapiesinhibitorsmoléculaires cibléesrénalestherapies

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  • Discussion of future directions, including early identification and clinical trials.

    • Main Results:

    • Brain metastases occur in up to 10% of metastatic RCC patients, associated with poor survival.
    • Prognostic scores incorporating metastatic volume and performance status aid survival prediction.
    • Stereotactic radiation therapy is a primary treatment, but systemic therapies like antiangiogenics and immune checkpoint inhibitors offer limited control.

    Conclusions:

    • Effective management of brain metastases in renal cell carcinoma remains an unmet need.
    • Early patient identification and the development of targeted clinical trials are essential.
    • Further research is needed to improve systemic treatment efficacy and patient outcomes.