INTEGRATION OF SURGERY AND MOLECULAR TARGETED THERAPY IN ADVANCED RENAL CELL CARCINOMA
Authors:
Milan Hora 1; Petr Stránský 1; Viktor Eret 1; Ondřej Hes 2; Jindřich Fínek 3; Zdeněk Chudáček 4; Marko Babjuk 5
Authors place of work:
Urologická klinika LF UK a FN, Plzeň
1; Šiklův patologicko-anatomický ústav LF
UK a FN, Plzeň
2; Onkologické a radioterapeutické oddělení
LF UK a FN, Plzeň
3; Radiodiagnostické oddělení FN, Plzeň
4; Urologická klinika 2. LF UK a FNM, Praha
5
Published in the journal:
Ces Urol 2011; 15(3): 149-157
Category:
Review article
Summary
The targeted therapy of metastatic renal cell carcinoma (mRCC) was introduced 2006 and it has changed to a certain degree even surgical management of RCC. The purpose of this article is to summarize an integration of surgical and targeted therapy of mRCC. The targeted therapy consists of 3 groups of drugs: tyrosine kinase (TK) inhibitors (sorafenib, pazopanib), mammalian target of rapamycin () inhibitors (temsirolimus a everolimus) and monoclonal antibiodies of VEGF (bevacizumab).
We have evaluated available information gained especially from PubMed. The majority of knowledge is concerned with sunitinib.
The profit of a cytoreductive nephrectomy (CRNE) was proven during the period of cytokines. In targeted therapy period, we haven’t got results of ongoing prospective randomized trials yet, but some partial information from other trials show a possible profit of CRNE and targeted therapy. There are still no results about neoadjuvant and adjuvant therapy indication, some trials are ongoing. The downsizing of inoperable tumour can be anticipated only in 30% of patients after 2–3 cycles.
The CRNE is still indicated for patients in a good performance status. Laparoscopic approach is well accepted. Nephron-sparing surgery is sufficient, if technically possible. Insufficient effect of CRNE is in bad performance status patients, high-risk tumours, tumours ≥ T3, liver metastases, symptomatic metastases, retroperitoneal and mediastinal lymph nodes involvement, LDH elevation and albumin decline. The preoperative downsizing of tumour using targeted therapy is indicated only in selected patients. Neoadjuvant and adjuvant therapy are for the present purposes of clinical trials without indication in clinical practice. The preoperative withdrawal of TK inhibitor is recommended 24 hours at least, postoperative reuse minimally after 4 weeks. Bevacizumab is necessary to withdraw minimally 4 weeks preoperatively.
Key words:
nephrectomy, cytoreductive, targeted therapy, sunitinib.
Zdroje
1. Epidemiologie zhoubných nádorů v České republice, www.svod.cz
2. Kwan KG, Kapoor A. Cytoreductive nephrectomy in metastatic renal cell carcinoma: the evolving role of surgery in the era of molecular targeted therapy. Curr Opin Support Palliat Care 2009; 3: 157–165.
3. Polcari AJ, Gorbonos A, Milner JE, Flanigan RC. The role of cytoreductive nephrectomy in the era of molecular targeted therapy. In t J Urol 2009; 16: 227–233.
4. Dekernion JB, Ramming KP, Smith RB. The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol 1978; 120: 148–152.
5. Montie JE, Stewart BH, Straffon RA, et al. The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma. J Urol 1977; 117: 272–275.
6. Marcus SG, Choyke PL, Reiter R, et al. Regression of metastatic renal cell carcinoma after cytoreductive nephrectomy. J Urol 1993; 150: 463–466.
7. Mickisch GH, Garin A, van Poppel H, dePrijck L, Sylvester R. Radical nephrectomy plus interferon-a-based immunotherapy compared with interferon-a alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001; 358: 966–970.
8. Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Rov V, McGrath PC, Caton JR Jr, Munshi N, Crawford ED. Nephrectomy followed by interferon a-2b compared with interferon a-2b alone for metastatic renal-cell cancer. N Engl J Med 2001; 345: 1655–1659.
9. Bex A, Jonasch E, Kirkali Z, Majean A, Mulders P, Oudard S, Patard JJ, Powles T, Poppel H, Wood CG. Integrating surgery with targeted therapies for renal cell carcinoma: current evidence and ongoing trials. Eur Urol 2010; 58: 819–828.
10. Motzer RJ, Figlin RA, Hutson TE, et al. Sunitinib versus interferonalfa (IFN-a) as first-line treatment of metastatic renal cell carcinoma (mRCC): Updated results and analysis of prognostic factors. J Clin Oncol 2007; 25: 5024.
11. You D, Jeong IG, Ahn JH, Lee DH, Lee JL, Hong H, Ahn H, Kim CS. The value of cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy. J Urol 2011; 195: 54–59.
12. Choueiri TK, Xie W, Kollmannsberger C, North S, Knox JJ, Lampard JG, McDermott DF, Rini BI, Heng DY. The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol 2011; 185(1): 60–66.
13. Szczylik C, Porta C, Bracarda S, et al. Sunitinib in patients with or without prior nephrectomy (Nx) in an expanded access trial of metastatic renal cell carcinoma (mRCC). J Clin Oncol 2008; 26(Suppl): Abstract 5124.
14. Richey SL, Culp SH, Jonasch E, Corn PG, Pagliaro LC, Tamboli P, Patel KK, Matin SF, Wood CG, Tannir NM. Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. Ann Oncol 2010 (Epub ahead of print).
15. Zini L, Capitanio U, Perrotte P, Jeldres C, Shariat SF, Arjane P, Widmer H, Montorsi F, Patard JJ, Karakiewicz PI. Population-based assessment of survival after cytoreductive nephrectomy versus no surgery in patients with metastatic renal cell carcinoma. Urology 2009; 73(2): 342–346.
16. Culp SH, Tannir NM, Abel EJ, Margulis V, Tamboli P, Matin SF, Wood CG. CanWe Better Select Patients With Metastatic Renal Cell Carcinoma for Cytoreductive Nephrectomy? Cancer 2010; 116: 3378–3388.
17. Escudier B. Benefit of cytoreductive nephrectomy in metastatic RCC: do we learn from retrospective studies and small prospective studies? Ann Oncol 2011 (Epub ahead of print).
18. Clinical trials, www.clinicaltrials.gov
19. Bex A, van der Veldt AAM, Blank C, van den Eeertwegh AJM, Boven E, Horenblas S, Haanen J. Neoadjuvant sunitinib for surgically complex advanced renal cell cancer of doubtful resectability: initial experience with downsizing to reconsider cytoreductive surgery. World J Urol 2009; 27: 533–539.
20. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC. EAU Guidelines on Renal Cell Carcinoma: The 2010 Update. Eur Urol 2010; 58(3): 398–403.
21. Matin SF, Madsen LT, Wood CG. Laparoscopic cytoreductive nephrectomy: The M.D. Anderson cancer center experience. Urology 2006; 68: 528–532.
22. Krambeck AE, Leibovich BC, Lohse CM, Kwon ED, Zincke H, Blute ML. The role of nephron sparing surgery for metastatic (pM1) renal cell carcinoma. J Urol 2006; 176(5): 1990–1995.
23. Hutterer GC, Patard JJ, Colombel M, et al. Cytoreductive nephron sparing surgery does not appear to undermine disease-specific survival in patients with metastatic renal cell carcinoma. Cancer 2007; 110: 2428–2433.
24. Capitanio U, Zini L, Perrotte P, Sharlat SF, Jejdres C, Arjane P, Pharand D, Widmer H, Péloquin F, Montorsi F, Patard JJ, Karakiewicz PI. Cytoreductive partial nephrectomy does not undermine cancer control in metastatic renal cell carcinoma: a population-based study. Urology 2008; 72: 1090–1095.
25. Hellenthal NJ, Mansour AM, Hayn MH, Schwaab T. Is there a role for partial nephrectomy in patients with metastatic renal cell carcinoma? Urol Oncol 2011 (Epub ahead of print).
26. Patard JJ, Kim HL, Lam JS, et al. Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: An international multicenter study. J Clin Oncol 2004; 22(16): 3316–3322.
27. Tan MH, Kanesvaran R, Li H, Tan HL, Tan PH, Wong CF, Chia KS, Teh BT, Yuen J, Chong TV. Comparison of the UCLA Integrated Staging System and the Leibovich score in survival prediction for patients with nonmetastatic clear cell renal cell carcinoma. Urology 2010; 75(6): 1365–1370.
28. Abel EJ, Culp SH, Tannnir NM, Matin SF, Tamboli P, Jonasch E, Wood CG. Primary tumor response to targeted agents in patients with metatatic renal cell carcinoma. Eur Urol 2011; 59: 10–15.
29. Karakiewicz PI, Suardi N, Jeldres C, et al. Neoadjuvant sutent induction therapy may effectively down-stage renal cell carcinoma atrial thrombi. Eur Urol 2008; 53: 845–848.
30. Robert G, Gabbay G, Bram R, Wallerand H, Deminière C, Cornelis F, Bernhard JC, Ravaud A, Ballanger P. Case study of the month. Complete histologic remission after sunitinib neoadjuvant therapy in T3b renal cell carcinoma. Eur Urol 2009; 55(6): 1477–1480.
31. Patard JJ, Thuret R, Raffi A, Laguerre B, Bensalah K, Culine S. Treatment with sunitinib enabled complete resection of massive lymphadenopathy not previously amanable to excision in a patient with renal cell carcinoma, Eur Urol 2009; 55: 237–239.
32. Thomas AA, Rini BI, Lane BR, Garcia J, Dreicer R, Klein EA, Novick AC, Campbell SC. Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma. J Urol 2009; 181(2): 518–523.
33. Powles T, Kayani I, Blank C, Chowdhury S, Horenblas S, Peters J, Shamash J, Sarwar N, Boletti K, Sadev A, O‘Brien T, Berney D, Beltran L, Haanen J, Bex A. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol 2011 (in print), doi: 10.1093/annonc/mdq65
34. Harshman LC, Yu RJ, Allen GI, Srinivas S, Gill HS, Chung BI. Surgical outcomes and complications associated with presurgical tyrosine kinase inhibition for advanced renal cell carcinoma (RCC). Urol Oncol 2011 (Epub ahead of print).
35. Mariani P. The safety of perioperative bevacizumab use. J Chir (Paris) 2010; 147(Suppl 1): S12–S17.
36. Kavolius, J.P., Mastorakos, D.P., Pavlovich, C, et al. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998; 16: 2261–2266.
37. Van der Poel, H.G., Roukema, J.A., Horenblas, S, et al. Metastasectomy in renal cell carcinoma: a multicenter retrospective analysis. Eur Urol 1999; 35: 197–203.
38. Krishnamurthi V, Novick AC, Bukowski RM. Efficacy of multimodality therapy in advanced renal cell carcinoma. Urology 1998; 51: 933–937.
39. Rini BI, Shaw V, Rosenberg JE, et al. Patiens with metastatic renal cell carcinoma with longterm disease-free survival after treatment with sunitinib and resection of residual metastases. Clin Genitourin Cancer 2006; 5(3): 232–234.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2011 Číslo 3
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