There are several types of kidney cancer—renal cell carcinoma (RCC) is the most common. Traditionally resistant to radiation and conventional chemotherapy, invasive surgery has been the mainstay of treatment.
Until recently, the only drugs approved for use in advanced RCC were interleukin-2 and interferon-α. Unfortunately, only about a quarter of patients benefit from these treatments. This large unmet need, together with our increasing understanding of the genetic and molecular pathways that underlie RCC, has spurred development of a new generation of 'targeted' therapies. In the past 5 years, 6 of these therapies have been approved in the USA for advanced RCC.
The widespread assimilation of these new drugs into clinical practice has transformed the treatment of RCC, and prolonged the survival of patients with advanced forms of the disease. Set against this background, this specially-commissioned Nature Reviews Urology Focus provides an update on state-of-the-art approaches to the diagnosis, management and monitoring of kidney cancer.
An NPG library of relevant Reviews, Perspectives, Case Studies, News pieces and commentaries is also provided.
RESEARCH HIGHLIGHTS
Renal preservation improves cardiac and overall survival
Nick Groves-Kirkby
doi:10.1038/nrurol.2010.52
Nature Reviews Urology 7, 237 (2010)
Significant overall survival advantage for RCC patients treated with autologous tumor lysate vaccine
Lisa Hutchinson
doi:10.1038/nrurol.2010.71
Nature Reviews Urology 7, 301 (2010)
NEWS AND VIEWS
Positive surgical margins after partial nephrectomy
Sascha Pahernik & Markus Hohenfellner
doi:10.1038/nrurol.2010.58
Nature Reviews Urology 7, 240-242 (2010)
mRCC stage migration: implications for trial design and analysis
Alessandro Volpe
doi:10.1038/nrurol.2010.60
Nature Reviews Urology 7, 242-244 (2010)
An evolving role for immunotherapy in metastatic RCC
Riccardo Autorino & Giuseppe Di Lorenzo
doi:10.1038/nrurol.2010.64
Nature Reviews Urology 7, 305-307 (2010)
Pazopanib trial data cannot support first-line use
Claudio Jeldres, Maxine Sun, Paul Perrotte & Pierre I. Karakiewicz
doi:10.1038/nrurol.2010.65
Nature Reviews Urology 7, 307-308 (2010)
REVIEWS
Epidemiology and risk factors for kidney cancer
Wong-Ho Chow, Linda M. Dong & Susan S. Devesa
doi:10.1038/nrurol.2010.46
Nature Reviews Urology 7, 245-257 (2010)
Overall kidney cancer incidence shows signs of stabilizing, or even decreasing worldwide, except in the US, where renal cell carcinoma incidence continues to rise. This Review by Chow and colleagues discusses the descriptive incidence and changing prevalence of risk factor patterns of adult kidney carcinoma, both internationally and in the US.
Functional imaging of renal cell carcinoma
Nathan Lawrentschuk, Ian D. Davis, Damien M. Bolton & Andrew M. Scott
doi:10.1038/nrurol.2010.40
Nature Reviews Urology 7, 258-266 (2010)
PET–CT allows simultaneous capture and co-registration of functional and anatomical data. Here, Australian-based authors outline the current clinical status of this 'functional imaging' in renal cell carcinoma. New radiotracers and approaches—including radiolabeled monoclonal antibodies and imaging of tumor hypoxia—are touched on, and areas of future research discussed.
Long-term management of bilateral, multifocal, recurrent renal carcinoma
Gennady Bratslavsky & W. Marston Linehan
doi:10.1038/nrurol.2010.44
Nature Reviews Urology 7, 267-275 (2010)
In this Review, Bratslavsky and Linehan address the management of the challenging group of patients with bilateral, multifocal, recurrent renal cell carcinoma. They discuss the treatment options and outcomes for these patients, highlight the importance of maximal renal preservation, and outline a management strategy developed from their own experience in treating these patients.
Imaging renal cell carcinoma with ultrasonography, CT and MRI
Michael J. Leveridge, Peter J. Bostrom, George Koulouris, Antonio Finelli & Nathan Lawrentschuk
doi:10.1038/nrurol.2010.63
Nature Reviews Urology 7, 311-325 (2010)
The increasing incidence of renal cell carcinoma can be attributed in part to the growing use of abdominal imaging leading to more frequent incidental discovery of small renal masses. Here, the authors compare the advantages and limitations of several techniques for the evaluation of renal masses, as well as their roles in disease staging and surveillance.
Immunologic mechanisms in RCC and allogeneic renal transplant rejection
Jens Bedke & Arnulf Stenzl
doi:10.1038/nrurol.2010.59
Nature Reviews Urology 7, 339-347 (2010)
The immunologic microenvironments of renal allograft rejection and renal cell carcinoma (RCC) share a number of similarities, although the resulting immune responses are markedly different. This Review discusses the cellular and molecular mechanisms underlying allograft rejection and RCC immune evasion, and how immunotherapy might be used to induce tumor rejection.
Treatment of metastatic renal cell carcinoma
Maxine Sun, Giovanni Lughezzani, Paul Perrotte & Pierre I. Karakiewicz
doi:10.1038/nrurol.2010.57
Nature Reviews Urology 7, 327-338 (2010)
The advent of targeted therapies transformed the treatment of metastatic RCC. Sun et al. provide a comprehensive summary of the published evidence for the efficacy of immunotherapy, cytoreductive nephrectomy and targeted therapies in treating this disease. They highlight sequential approaches and offer clinical recommendations for the contemporary patient.
PERSPECTIVES
The genetic basis of kidney cancer: a metabolic disease
W. Marston Linehan, Ramaprasad Srinivasan & Laura S. Schmidt
doi:10.1038/nrurol.2010.47
Nature Reviews Urology 7, 277-285 (2010)
Each of the kidney cancer genes identified so far interact with cell metabolism pathways involved in energy, nutrient, iron or oxygen sensing. Here, Linehan and colleagues argue that targeting the fundamental cell metabolic abnormalities provides a unique opportunity to develop novel forms of therapy for this disease.
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