Abstract
In this article, we review de state of the art on the management of renal cell carcinoma (RCC) and provide recommendations on diagnosis and treatment. Recent advances in molecular biology have allowed the subclassification of renal tumours into different histologic variants and may help to identify future prognostic and predictive factors. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. No adjuvant therapy has demonstrated a clear benefit in overall survival. Considering the whole population of patients with advanced disease, the combination of axitinib with either pembrolizumab or avelumab increase response rate and progression-free survival, compared to sunitinib, but a longer overall survival has only been demonstrated so far with the pembrolizumab combo. For patients with IMDC intermediate and poor prognosis, nephrectomy should not be considered mandatory. In this subpopulation, the combination of ipilimumab and nivolumab has also demonstrated a superior response rate and overall survival vs. sunitinib. In patients progressing to one or two antiangiogenic tyrosine-kinase inhibitors, both nivolumab and cabozantinib in monotherapy have shown benefit in overall survival compared to everolimus. Although no clear sequence can be recommended, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in patients with metastatic RCC.
Highlights
Renal cell carcinoma (RCC), which originate within the renal cortex, are responsible for 80–85% of all primary renal neoplasms
2–3% of kidney cancer cases are related to an autosomal dominant inheritance, the most frequent of whom is the von Hippel–Lindau syndrome associated with clear-cell RCC
This guideline has been developed based on the consensus of ten genitourinary medical oncologists, designed by the Spanish Society of Medical Oncology (SEOM) and the Spanish Oncology Genitourinary Group (SOGUG), with the purpose of reviewing and summarizing the available evidence regarding the management of RCC, as well as generating evidence-based statements on diagnostics and therapeutic strategies
Summary
This guideline has been developed based on the consensus of ten genitourinary medical oncologists, designed by the Spanish Society of Medical Oncology (SEOM) and the Spanish Oncology Genitourinary Group (SOGUG), with the purpose of reviewing and summarizing the available evidence regarding the management of RCC, as well as generating evidence-based statements on diagnostics and therapeutic strategies. Systematic reviews and meta-analysis of well-designed randomized clinical trials, not included, have been considered as level of evidence I. Recommendations are based on current evidence, but the local regulatory status of drugs and procedures should be considered by the reader. That more than 50% of renal cell carcinomas (RCC) are detected incidentally and few patients (6–10%) have the classic symptoms of the triad (flank pain, macroscopic hematuria and palpable abdominal mass). Patients present with symptoms resulting from metastatic disease including bone pain or persistent cough. The sensitivity of CT for small renal masses is higher than 90%, approaching 100% for lesions larger than 2 cm [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
