Neoadjuvant and adjuvant strategies in renal cell carcinoma: more questions than answers

Anticancer Drugs. 2011 Jan:22 Suppl 1:S4-8. doi: 10.1097/01.cad.0000390766.47540.07.

Abstract

The current standard treatment for early stage (I-III) renal cell cancer (RCC) is surgery. While the prognosis of stage I tumors is excellent, stage II and particularly stage III have a high risk of relapse. The adjuvant treatment of patients with RCC remains an area of investigation, with patient selection being a key aspect. There are currently two prognostic nomograms to establish the risk of relapse in patients with resected RCC. The results of earlier studies of adjuvant therapy, including the use chemotherapy and/or immunotherapy after nephrectomy have failed to show any benefit in the outcome of patients at risk of developing local recurrence or distant metastases. Two recent phase III trials with vaccines (autologous tumor cell vaccine and autologous tumor-derived heat shock protein peptide complex-96) have shown promising, albeit still preliminary, results. In the metastatic RCC setting, recent advances in the molecular understanding of oncogenic pathways have led to the development of new therapeutic strategies with the use of targeted therapies in the adjuvant setting. Neoadjuvant treatment is another treatment modality currently being evaluated for patients with early disease and in patients with metastatic RCC with inoperable primary tumors. The questions that remain unanswered include activity of these agents in early stages of the disease, patient selection, optimal start time of the adjuvant treatment, and finally, the optimal length of treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adjuvants, Immunologic / therapeutic use*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cancer Vaccines / administration & dosage
  • Cancer Vaccines / therapeutic use
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / surgery*
  • Chemotherapy, Adjuvant
  • Clinical Trials, Phase III as Topic
  • Combined Modality Therapy
  • Humans
  • Immunotherapy
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / surgery*
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Nephrectomy
  • Prognosis

Substances

  • Adjuvants, Immunologic
  • Antineoplastic Agents
  • Cancer Vaccines