Systemic and local therapies for patients with metastatic renal cell carcinoma (mRCC) are often challenging despite evolution of multimodal cancer therapies in the last decade. In this review, we will focus on recent multidisciplinaryapproaches for patients with mRCC.
Systemic therapy for patients with mRCC has been garnering attention particularly after the approval of immuno-oncology (IO) agents, including anti-programmed death 1/programmed death-ligand 1. IO combinations have also significantly prolonged overall survival in patients with mRCC in the first-line setting. Regarding local therapies, cytoreductive nephrectomy (CN) have become less common in the post-Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques (CARMENA) trial era, even though CN may still benefit selected patients with mRCC. In addition, metastasis-directed local therapies, namely metastasectomy or stereotactic radiotherapy, particularly for oligo-metastatic lesions or brain metastases, may also have a prognostic impact. Several ablative techniques are also evolving while maintaining high local control rates with acceptable safety.
Multimodal cancer therapies are essential for conquering complex cases of mRCC. Modern systemic therapies including IO-based combination therapy as well as local therapies including CN, metastasectomy, stereotactic radiotherapy, and ablative techniques appear to improve oncologic outcomes of patients with mRCC, although appropriate patient selection is indispensable.
Expert review of anticancer therapy. 2024 May 30 [Epub ahead of print]
Martin Zarba, Ryo Fujiwara, Takeshi Yuasa, Fumitaka Koga, Daniel Y C Heng, Kosuke Takemura
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada., Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan., Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.