Thérapies ciblées néo-adjuvantes dans le cancer du rein

Abstract

Targeted molecules are used in the treatment of metastatic kidney cancer. Their use before surgery could reduce tumor volume, facilitate surgical resection and treat micrometastases. In this literature review, we present the main results of studies that evaluated the benefit of targeted therapies in kidney cancer. This article is based on a systematic literature search by using Pubmed database. In prospective studies, a decrease in the size of the primary tumor has been reported to be 9.6 to 28.3%. In case of metastatic kidney cancer, cytoreductive nephrectomy could be possible after targeted therapies in tumors that initially were not available for surgery. In localized kidney cancer, a reduction of tumor volume of more than 30% is obtained in 5 to 45% of cases after neoadjuvant targeted therapies. Their use is associated with the occurrence of the usual side effects of targeted therapies plus a specific risk of delayed healing and metastatic progression during the perioperative period. The study of tumors after surgery shows a lower efficiency of the production of tumor necrosis in non-clear cell carcinomas. Data from the literature are not currently in favor of neoadjuvant use of targeted therapies in the treatment of kidney cancer. Prospective studies will be required to determine their interest in the prevention of metastatic recurrence after surgery.