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Renal Cell Cancer

by: Choueiri, Toni K., M.D.

Renal Cell Cancer

by: Choueiri, Toni K., M.D.

ISBN 13:
9781455711031
ISBN 10:
1455711039
Edition: 1st
Format: Hardcover
Copyright: 08/01/2011
Publisher: SAUNDERS W B CO

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Summary

Topics for this issue will include: Epidemiology of RCC;New Insights into the Biology of RCC;Pathology of Renal Neoplasms;Imaging in RCC;Small Renal Tumors: Prognosis and Management;The Role of Surgery in the management of RCC: Nephrectomy and metastatectomy;Cytoreductive Nephrectomy: Rationale and current Applications;Adjuvant Therapies in RCC and Management of Side Effects from Current Therapies in RCC

Preface: Renal Cell Carcinoma	p. xiii
Epidemiology of Renal Cell Cancer	p. 651
Renal cell cancer (RCC) is increasingly diagnosed at an early stage in many countries, with likely contributes to the recent levelling of RCC mortality in the United States and many European countries. However, over all stages nearly 50% of the patients die within 5 years after diagnosis, smoking and obesity may account for approximately 40% of all incidental cases in high-risk countries. Besides obesity, rising prevalence of hypertension may play a growing role. Several other occupational and lifestyle factors may also affect the risk of RCC. Genetic variations may be an important factor in the differing incidence among populations.
New Insights into the Biology of Renal Cell Carcinoma	p. 667
Ninety percent or more of kidney cancers are believed to be of epithelial cell origin, and are referred to as renal cell carcinoma (RCC), which are further subdivided based on histology into clear-cell RCC (75%), papillary RCC (15%), chromophobe tumor (5%), and oncocytoma (5%). Some genes confer an increased risk of these various histologic RCC subtypes. In practice, there is some overlap among the histologic substyles, and there are some shared molecular features among these tumor types. This review focuses primarily on the most common form of RCC, clear-cell renal carcinoma, noting some recent addvances in the other histologic subtypes.
Imagin in Renal Cell Carcinoma	p. 687
Imaging plays a central role in the detection, diagnosis, staging, and follow-up of renal cell carcinoma (RCC). Most renal masses are incidentally detected with modern, high-resolution imaging techniques and a variety of management optiions exist for the renal masses encountered today. This article discusses the role of multiple imaging modalities in the diagnosis of RCC and the imaging features of specific pathologic subtypes and staging techinques. Future directions in RCC imaging are presented, including dynamic contrast-enhanced and unenhanced techniques, as well as the development of novel tracers for positron emission tomography.
Small Renal Masses: Risk Prediction and Contemporary Management	p. 717
The majority of kidney cancer tumors are small renal masses (SRMs). Partial nephrectomy is now established as the preferred treatment modality. In some patients the potential morbidity may outweigh the oncologic risk. Based on active survelliance studies, restriction of radical therapy to patients with aggressive tumors has been proposed. This had spurred renewed interest in development of radiologic and biopsy-based diagnostic techinques that can identify high-risk disease. This article discusses the natural history and pathologic features of SRMs, the evolving role of biopsy, and provides an overview of ourcomes of various treatment approaches and current recommendations for management.
The Role of Surgery in the Management of Early-Stage Renal Cancer	p. 737
There were an estimated 58,240 new cases and 13,040 deaths from kidney cancer in the United States in 2010. The increased treatment and cure of small, incidentaly discovered renal tumors, most of which are nonlethal in nature, has not offset the increased mortality cased by advanced and metastatic tumors. In this article, the optimum approach to the surgical management of localized renal tumors and its impact on renal function are discussed.
The Role of Surgery in Advanced Renal Cell Carcinoma: Cytoreductive Nephrectomy and Metastasectomy	p. 753
Renal cell carcinoma (RCC) is considered a relatively rare malignancy worldwide. Around a thrid of patients with RCC present with metastatic disease, and among those patients treated with nephrectomy with curative intent, more than one-third develop metastases during postoperative follow-up. Due to the absence of curative medical treatements for metastatic RCC, surgery remains the mainstay of therapy. Surgery plays a key role in two aspects: cytoreductive nephrectomy to remote the primary renal tumor in the presence of know metastatic disease, and metastasectomy to remove distant metastatic fol in patients with metastatic RCC.
Adjuvant and Neoadjuvant Therapies in HIgh-Risk Renal Cell Carcinoma	p. 765
The standard of care for renal cell carcinoma (RCC) is surgical resection as a monotherapy or as part of a multimodal approach. A significnat number of patients undergoing surgery for localized RCC experience recurrence, suggesting that there are some individuals in whom surgical excision is necessary but insufficient because of the presence of micrometastatic disease at diagnosis. This review summarizes current algorithms used to indentify patients at high risk for disease recurrence following the surgical resection of RCC, the outcomes of contemporary adjuvant systemic therapy trials, and the rationale supporting the use of neoadjuvant therapy.
Immunotherapy for Renal Cell Carcinoma	p. 793
Although several cytokines have shown antitumor activity in renal cell carcinoma (RCC), the most consistent results have been reported with interleukin-2 (IL-2) and interferon (IFN). Recent insights into how the immune response to a tumor is regulated hold the promise of allowing patients to obtain a durable response to immunotherapy, perhaps without the significant toxicity associated with conventional approaches. This review describes how improvements in patient selection, combination therapy, and investigational agents might expand and better define the role of immunotherapy in metastatic RCC.
Vascular Endothelial Growth Factor-Targetend Therapies in Advanced Renal Cell Carcinoma	p. 813
Vascular endothellal growth factor (VEGF) is, to date, the key element in the pathogenesis of renal cell carcinoma (RCC). VEGF pathway activation is responsible for the recruitment, migration, and expansion of endothelial cell, with this angiogenesis tumor model being characteristic of RCC, Different strategies have been developed for almost a decade to block the VEGF pathway in this setting. Four different compunds were approved for metastatic RCC (mRCC) in the past 6 years: bevacizumab, sunitinib, sorafenib, and pazopanib. Anitinib and tivozanib are also promising compounds under evaluation. The revolution in the managemkent and prognosis of patients with mRCC is ongoing.
MTOR Inhibitors in Advanced Renal Cell Carcinoma	p. 835
Better understanding of the molecular biology of renal cell carcinoma (RCC) has led to the development of several targeted anti-cancer agents, several of which have since received approval for treatment of advanced disease. Two of these, the intravenous agent temsirolimus and the oral everolimus, exhibit antitumor effects through inhibition of the mammalian target of rapamyclin (mTOR) pathway. This article reviews their mechanisms of action in the context of the current understanding of RCC pathophysiology, the clinical data leading to their approval, class-specific toxicities, potential molecular mechanisms behind treatment resistance and novel treatment approaches for RCC that incorporate mTOR blockade.
Systemic Therapy for Metastatic Non-Clear-Cell Renal Cell Carcinoma: Recent Progress and Future Directions	p. 853
Insights into the biology of clear-cell renal cell carcinoma (CCRCC) have identified multiple pathways associated with the pathogenesis and progression of this cancer. This progress has led to the development of multiple agents targeting these pathways, including the tyrosine kinase inhibitors sorafenib, sunitinib, and pazopanib, the monoclonal antibody bevacizumab, and the mTOR inhibitors temsirolimus and everollimus. With the exception of temsirolimus, phase 3 trials tested these agents in patients with clear-cell histology; therefore, their efficacy in non-CCRCC is unclear. To date, there is no established effective therapy for patients with advanced non-CCRCC. This article focuses on treatement options for metastatic non-CCRCC.
Clinical and Molecular Prognostic Factors in Renal Cell Carcinoma: What We Know So Far	p. 871
The current treatment paradigm for metastatic renal cell carcinoma (RCC) includes agents that target the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways. Because these agents have revolutionized RCC over the past five years, new clinical and molecular predictive and prognostic tools are required. These are potentially important for therapy selection, patient councelling, and clinical trial stratification. This review examines clinical prognostic model sand molecular biomarkers in RCC.
Management of Treatment-Related Toxicity with Targeted Therapies for Renal Cell Carcinoma: Evidence-Based Practice and Best Practices	p. 893
The advent of targeted agents of the treatment of advanced renal cell carcinoma has led to dramatic improvements in therapy. However, the chronic use of these medications had also led to the indentification of new toxicities that require long-term management. Effective manangement of texicities that require long-term management. Effective management of texicity is needed to maximize the benefits of treatment and improve patients' quality of life. In addition, toxicity from these agents may affect treatment compliance, particularly with daily oral agents. This review delineates the toxicities that require monitoring, the underlying pathophysiology (when known), and treatments that may have benefits in relieving symptoms and side effects.
Future Directions in Renal Cell Carcinoma: 2011 and Beyond	p. 917
Emerging from a largely cytokine-based era, the last several years have witnessed a dramatic change in the therapeutic landscape of renal cancer. Molecularly targented and antiangiogenic agents now form the backbone of most therapeutic strategies for patients with advanced renal cell carclnoma (RCC). Although the next few years may not see such broad paradigm shifts, these remains significant room for improvement in the care of patients with RCC. This review discusses challenges that faces physicians and researchers as well as innovations that may contribute to improving the therapeutic outcomes for patients with RCC.
Index	p. 937
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Renal Cell Cancer

Renal Cell Cancer

9781455711031

1455711039

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