Advanced kidney cancer - current trends in treatment (part 2)

Renal cell carcinoma (RCC) is the most malignant urological tumour and the incidence of RCC in the Czech Republic is currently highest

in the world. The overview has 2 parts. In part 1. the authors present some current facts about epidemiology, molecular pathophysilogy

of RCC, general mechanism of new molecularly targeted biological therapies with antiangiogenic drugs, importance of cytoreductive

nephrectomy in cytokines era and about of current regimes of systemic antiangiogenic therapies. In part 2. the surgical therapy or new

alternative methods of minimally invasive procedures incorporated in current complex treatmet strategies of advanced or metastatic

RCC together with biological systemic therapy are discussed. The authors focus attention also on prognostic factors and individual profiles

of patients (histological subtypes of RCC, performance status etc.) which can be used to predict outcomes in complex algotithm to

facilitate treatment decision-making in everyday clinical practice with new targeted treatment regimes. Basic treatment modality for

localized disease is surgical therapy. But significant number of patients are still primarily diagnosed in advanced or metastatic stage of

disease. Complex care and interdisciplinary approach with integration of surgery and systemic medication with best supportive care on

individual basis is optimal method of treatment for a patients with advanced or metastatic RCC. In recent years also minimally invasive

methods for treatment of metastases has become an established and important equivalent to conevtional surgical procedures in some

cases. Especially for high-risk and polymorbid patients we used for example radiofrequency ablation. Systemic therapy for metastatic RCC

with new two antiangiogenics drugs: an oral oxindol tyrosine kinase inhibitor – sunitinib (Sutent®) and with an oral multikinase inhibitor

– sorafenib (Nexavar®) is more effective than previous immunotherapy with cytokines (interleukin-2 and interferon-alpha). Another

medicaments such as bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus are currently also successfully used for a treatment

of metastatis disease. Bone metastases of RCC can lead to debilitating skeletal complicatinons. Zoledronic acid (Zometa®) significantly

delays the onset and reduces the incidence of skeletal-related events and demonstrated trends for longer overall survival in these p

Keywords: kidney cancer, targeted therapy, biological treatment, antiangiogenics drugs, tyrosine kinase inhibitor, sunitinib (Sutent®), sorafenib (Nexavar®), bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus, immunotherapy, cytokines, interleukin-2, interferonalpha, zoledronic acid (Zometa®), nephrectomy, metastasectomy, radiofrequency ablation.