Management of Advanced Renal Cell Carcinoma

Area of Science:

• Oncology
• Nephrology
• Immunotherapy

Background:

• Advanced renal cell carcinoma (RCC) management has seen significant evolution.
• Clear cell RCC, the main subtype, is treated with immune checkpoint inhibitors (ICI), anti-VEGF tyrosine kinase inhibitors (TKI), and mTOR inhibitors.

Purpose of the Study:

• To provide a comprehensive overview of current treatment strategies for advanced RCC.
• To discuss systemic therapies for clear cell and non-clear cell RCC subtypes.
• To cover management of treatment-associated toxicities and the role of local therapies.

Main Methods:

• Review of current systemic treatment strategies for advanced RCC.
• Analysis of immune checkpoint inhibitors (ICI), anti-VEGF tyrosine kinase inhibitors (TKI), and mTOR inhibitors.
• Consideration of local therapies for oligometastatic or oligoprogressive disease.

Main Results:

• Immune checkpoint inhibitor (ICI) combination therapy is standard for first-line treatment of clear cell RCC.
• ICI combination therapies show benefit in non-clear cell RCC.
• Local therapies like cytoreductive nephrectomy, metastasectomy, or stereotactic radiation are options for selected patients.

Conclusions:

• ICI application in early RCC presents challenges for subsequent therapies and toxicity management.
• Systemic treatment for non-clear cell RCC is evolving, with recent data supporting ICI combinations.
• Tyrosine kinase inhibitors, mTOR inhibitors, and Belzutifan are used in subsequent treatment lines for advanced RCC.