Since 2004, there have been substantial advances in the treatment of renal cancer. However, surgery (radical or partial nephrectomy) remains the only cure for renal cancer, which is detected and diagnosed in the early stages. Surgical techniques, such as cryotherapy and radiofrequency ablation, which reduce the burden on the patient and the NHS by shortening recovery times, have been developed and tested for the treatment of renal carcinomas. These techniques are still experimental and more experience is required before renal surgeons generally accept them.
Immunotherapy has been around since 1984, but it is a non-specific and fairly toxic treatment for advanced renal cancer. Since 2004, a number of new biological therapies offering targeted treatment for advanced renal cancer have been developed; sunitinib (Sutent®) and sorafenib (Nexavar®) were launched in 2004, and by the year 2014, axitinib (Inlyta®), bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus (Afinitor ®), and pazopanib (Votrient®) were available on the market. cabozantinib (cabometyx) and Tivozanib (Fotiva) followed. However, even with these new advances in drug development, there remain a number of challenges for medical oncologists treating patients with renal cell carcinoma:
- Which is the best first-line therapy?
- Can treatment be individualised, as is the case for breast cancer?
- What is the role of nephrectomy, especially in patients with metastatic disease?
- Which is the best second- and third-line treatment?
All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is to ensure that they are effective, they offer advantages over current available treatments, and they are safe. All new treatments undergo rigorous testing in the laboratory and the clinic (clinical trials) before they are awarded a license for use in the UK. Until studies are completed and new treatments are found to be more effective than existing treatments, they cannot be used as standard therapy for renal cancer. For new systemic treatments, this testing process can take anything up to 20 years to complete. This module describes the new approaches to the treatment of renal cancer, most of which are, at the time of writing, the subject of ongoing research.
Learning Objectives
At the end of this Module learners will be able to:
- Talk about the epidemiological research into the risk factors associated with renal cancer.
- Describe the ongoing developments in the surgical treatments for renal cancer.
- Show awareness of the advances in systemic treatment for renal cancer, in particular combination therapies, new biological therapies and vaccines.
- Describe how individualised treatments will ultimately benefit renal cancer patients