Personalised medicine in renal cell tumours

Abstract

The extensive use of abdominal imaging reveals an increasing number of small and asymptomatic kidney tumours, for which primary treatment versus observation strategies need to be discussed. Elaborate surgical techniques and a variety of systemic treatment options are available for patients with localised and advanced tumours. This necessitates a demanding and complex individualised decision-making process. A better understanding of tumour biology including validated biomarkers is therefore essential in order to improve diagnostics, prognostic evaluation and therapeutic strategies.Renal cell tumours are currently subdivided into 16 histological subtypes, each characterised by specific genetic changes. As tumour aggressiveness differs significantly, knowledge of these distinct subtypes is important for adequate treatment choice and follow-up. Molecular markers may facilitate an exact diagnosis and will further differentiate the individual prognosis within each subtype, which is already possible for clear cell renal cell carcinoma (RCC). This will lead to individualised follow-up protocols and a better selection of patients benefitting from observational or adjuvant strategies after surgery.For metastatic tumours, the number of systemic treatment options targeting specific cellular signal or communication pathways has increased tremendously. Valid predictive biomarkers for differential treatment are not available to date. However, there is promising evidence of correlations between molecular signatures and treatment response to tyrosine kinase inhibitors or checkpoint inhibitors. Biomarkers will most likely supersede clinical scores for individual treatment selection in the near future.Prospective multicentre studies are needed so that promising biomarkers can be implemented in daily clinical practice in due consideration of existing insights from the tumour biology of the distinct RCC subtypes. This is essential for further improvement of diagnosis and treatment.