Renal cancer biomarkers: the promise of personalized care

Naveen S Vasudev,Rosamonde E Banks,Peter J Selby

doi:10.1186/1741-7015-10-112

Naveen S Vasudev, Rosamonde E Banks + Show 1 more

Open Access

https://doi.org/10.1186/1741-7015-10-112

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Abstract

Significant advances in our understanding of the biology of renal cell carcinoma (RCC) have been achieved in recent years. These insights have led to the introduction of novel targeted therapies, revolutionising the management of patients with advanced disease. Nevertheless, there are still no biomarkers in routine clinical use in RCC. Tools used routinely to determine prognosis have not changed over the past decade; classification remains largely morphology based; and patients continue to be exposed to potentially toxic therapy with no indication of the likelihood of response. Thus the need for biomarkers in RCC is urgent. Here, we focus on recent advances in our understanding of the genetics and epigenetics of RCC, and the potential for such knowledge to provide novel markers and therapeutic targets. We highlight on-going research that is likely to deliver further candidate markers as well as generating large, well-annotated sample banks that will facilitate future studies. It is imperative that promising candidates are validated using these resources, and in subsequent prospective clinical trials, so that future biomarkers may be used in the clinic to personalize patient care.

Highlights

Significant advances in our understanding of the biology of renal cell carcinoma (RCC) have been achieved in recent years
Central to the biology of clear cell renal cell carcinoma (ccRCC), which form the focus of this review, is loss of function of the Von Hippel-Lindau (VHL) tumour suppressor gene (TSG), located on chromosome 3p
Loss of function of the VHL protein leads to stabilisation of hypoxia-inducible factors, nuclear transcription factors that in turn can activate the transcription of many genes including those encoding vascular endothelial growth factor (VEGF) and platelet derived growth factor

Summary

Introduction

Significant advances in our understanding of the biology of renal cell carcinoma (RCC) have been achieved in recent years These insights have led to the introduction of novel targeted therapies, revolutionising the management of patients with advanced disease. Current nomograms used to determine risk are still based on clinicopathological criteria only, and were developed more than a decade ago [5] Such scoring systems are reasonably accurate at a population level but distinguishing risk for individuals, those deemed at intermediate risk, remains poor. This is a key area where biomarkers are urgently required in RCC. Variably examining clinicopathological criteria, VHL status, serum cytokines and angiogenic factors in relation to TKI response have been published, and reviewed elsewhere [8]

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