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Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma

Background: Approximately 16% of patients with renal cell carcinomas (RCC) present with stage IV disease at time of diagnosis. Treatment options for metastatic clear cell RCC, the most common histologic subtype, have proliferated over the past decade and include a combination of surgery and systemic...

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Autores principales: Pilié, Patrick G., Jonasch, Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179116/
https://www.ncbi.nlm.nih.gov/pubmed/30334005
http://dx.doi.org/10.3233/KCA-170009
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author Pilié, Patrick G.
Jonasch, Eric
author_facet Pilié, Patrick G.
Jonasch, Eric
author_sort Pilié, Patrick G.
collection PubMed
description Background: Approximately 16% of patients with renal cell carcinomas (RCC) present with stage IV disease at time of diagnosis. Treatment options for metastatic clear cell RCC, the most common histologic subtype, have proliferated over the past decade and include a combination of surgery and systemic therapy. The selection of systemic agent and best timing of systemic therapy in relation to nephrectomy is an area of active research. Objective: To evaluate the evidence for perioperative systemic therapy, including presurgical and postsurgical, for metastatic RCC. Methods: A systematic literature search using PubMed and MEDLINE databases was performed in January 2017 for articles related to perioperative systemic therapy in metastatic RCC using key word search terms. The authors screened the search results and identified selected publications by predetermined inclusion criteria and consensus. Expert opinion was obtained to assess for publications missed by search. Results: Early phase clinical trials of antiangiogenic tyrosine kinase inhibitors prior to cytoreductive nephrectomy in select patients show that these systemic agents are safe and effective in the presurgical setting. There are no randomized data evaluating pre- or post-surgical systemic therapy in metastatic RCC. Conclusions: Retrospective and early-phase prospective studies on the use and timing of systemic therapy in relation to cytoreductive nephrectomy in metastatic RCC show that standard of care antiangiogenic agents are safe and effective in the perioperative setting, though randomized data are still lacking. Pre-surgical immune checkpoint therapy for metastatic RCC has strong biologic rationale and holds promise. Sequential tumor sampling in neoadjuvant and presurgical trials is necessary to determine biomarkers of response and resistance.
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spelling pubmed-61791162018-10-15 Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma Pilié, Patrick G. Jonasch, Eric Kidney Cancer Research Report Background: Approximately 16% of patients with renal cell carcinomas (RCC) present with stage IV disease at time of diagnosis. Treatment options for metastatic clear cell RCC, the most common histologic subtype, have proliferated over the past decade and include a combination of surgery and systemic therapy. The selection of systemic agent and best timing of systemic therapy in relation to nephrectomy is an area of active research. Objective: To evaluate the evidence for perioperative systemic therapy, including presurgical and postsurgical, for metastatic RCC. Methods: A systematic literature search using PubMed and MEDLINE databases was performed in January 2017 for articles related to perioperative systemic therapy in metastatic RCC using key word search terms. The authors screened the search results and identified selected publications by predetermined inclusion criteria and consensus. Expert opinion was obtained to assess for publications missed by search. Results: Early phase clinical trials of antiangiogenic tyrosine kinase inhibitors prior to cytoreductive nephrectomy in select patients show that these systemic agents are safe and effective in the presurgical setting. There are no randomized data evaluating pre- or post-surgical systemic therapy in metastatic RCC. Conclusions: Retrospective and early-phase prospective studies on the use and timing of systemic therapy in relation to cytoreductive nephrectomy in metastatic RCC show that standard of care antiangiogenic agents are safe and effective in the perioperative setting, though randomized data are still lacking. Pre-surgical immune checkpoint therapy for metastatic RCC has strong biologic rationale and holds promise. Sequential tumor sampling in neoadjuvant and presurgical trials is necessary to determine biomarkers of response and resistance. IOS Press 2017-07-26 /pmc/articles/PMC6179116/ /pubmed/30334005 http://dx.doi.org/10.3233/KCA-170009 Text en © 2017 – IOS Press and the authors. All rights reserved https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Report
Pilié, Patrick G.
Jonasch, Eric
Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title_full Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title_fullStr Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title_full_unstemmed Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title_short Systematic Review: Perioperative Systemic Therapy for Metastatic Renal Cell Carcinoma
title_sort systematic review: perioperative systemic therapy for metastatic renal cell carcinoma
topic Research Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179116/
https://www.ncbi.nlm.nih.gov/pubmed/30334005
http://dx.doi.org/10.3233/KCA-170009
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