State of the Art: Multidisciplinary Management of Oligometastatic Renal Cell Carcinoma

Dason, Shawn; Lacuna, Kristine; Hannan, Raquibul; Singer, Eric A.; Runcie, Karie

doi:10.1200/edbk_390038

Cited by 11 publications

(6 citation statements)

References 89 publications

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“…As late metachronous recurrences generally have lower disease burden and higher proportion of favorable risk patients, these patients are probably be good AS candidates. Some patients presenting with synchronous mRCC are treated with cytoreductive nephrectomy, a highly nuanced decision ( 39 ). As cytoreductive nephrectomy is typically done to control the bulkiest and most symptomatic disease burden, those eligible for cytoreductive nephrectomy are also considered for AS.…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance in Metastatic Renal Cell Carcinoma

Beecroft,

D. Gauntner,

Upadhyay

et al. 2024

jkcvhl

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Metastatic renal cell carcinoma (mRCC) is a heterogenous disease with a variable clinical course. While therapies for treatment of this condition have progressed, they are not without toxicity. In some patients, active surveillance (AS) of this disease is increasingly considered to delay its toxicity. This article seeks to review the literature and discuss management of metastatic renal cell carcinoma, specifically regarding upfront AS, the role of radiation therapy in delaying systemic therapy, and surveillance after initial treatment with systemic therapy. Median time on AS prior to initiation of systemic therapy ranged from 14 to 60 months across studies. AS is appropriate to offer in favorable or intermediate risk, asymptomatic, and systemic treatment naïve patients with mRCC.

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Section: Discussionmentioning

confidence: 99%

Active Surveillance in Metastatic Renal Cell Carcinoma

Beecroft,

D. Gauntner,

Upadhyay

et al. 2024

jkcvhl

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“…This study is also seminal in expanding the role of stereotactic ablative radiotherapy in renal cell carcinoma beyond localized RCC. SABR is being studied across the disease spectrum of RCC, including: Primary or neoadjuvant treatment for patients with inferior vena cava tumor thrombus 27 – 29 Metastasis directed therapy as an alternative to metastasectomy 30 Cytoreductive treatment as an alternative to cytoreductive nephrectomy 31 Treatment of oligoprogressive disease to prolong a response to systemic therapy 32 …”

Section: International Radiosurgery Oncology Consortium For Kidney (I...mentioning

confidence: 99%

Paradigm Shifting Research: Key Studies in Urologic Oncology

Dason,

Lee

2024

Ann Surg Oncol

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Background Genitourinary malignancies have a substantial impact on men and women in the USA as they include three of the ten most common cancers (prostate, renal, and bladder). Other urinary tract cancers are less common (testis and penile) but still have profound treatment implications related to potential deficits in sexual, urinary, and reproductive function. Evidenced-based practice remains the cornerstone of treatment for urologic malignancies. Methods The authors reviewed the literature in consideration of the four top articles influencing clinical practice in the prior calendar year, 2022. Results The PROTECT trial demonstrates favorable 15-years outcomes for active monitoring of localized prostate cancer. The SEMS trial establishes retroperitoneal lymph node dissection as a viable option for patients with seminoma of the testis with limited retroperitoneal lymph node metastases. CheckMate 274 supports adjuvant immunotherapy following radical cystectomy for muscle-invasive bladder cancer with a high risk of recurrence. Data reported from the IROCK consortium reinforce stereotactic ablative radiotherapy as an option for localized renal cell carcinoma. Conclusion The care for patients with urologic cancers has been greatly improved through advances in surgical, medical, and radiation oncologic treatments realized through prospective randomized clinical trials and large multicenter collaborative groups.

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“…Oligometastatic (OM) disease involves metastatic lesions with limited spread; this is typically a maximum of five lesions, though criteria to define oligometastatic disease across solid tumor malignancies are evolving [ 84 ]. Metastatic-directed therapy (MDT) was historically performed through surgical measures, but has more recently expanded to include SBRT [ 85 ].…”

Section: Role Of Radiation Therapymentioning

confidence: 99%

Treatment Landscape of Renal Cell Carcinoma

Chen,

Wang,

Panian

et al. 2023

Curr. Treat. Options in Oncol.

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Opinion StatementThe treatment landscape of renal cell carcinoma (RCC) has evolved significantly over the past three decades. Active surveillance and tumor ablation are alternatives to extirpative therapy in appropriately selected patients. Stereotactic body radiation therapy (SBRT) is an emerging noninvasive alternative to treat primary RCC tumors. The advent of immune checkpoint inhibitors (ICIs) has greatly improved the overall survival of advanced RCC, and now the ICI-based doublet (dual ICI-ICI doublet; or ICI in combination with a vascular endothelial growth factor tyrosine kinase inhibitor, ICI-TKI doublet) has become the standard frontline therapy. Based on unprecedented outcomes in the metastatic with ICIs, they are also being explored in the neoadjuvant and adjuvant setting for patients with high-risk disease. Adjuvant pembrolizumab has proven efficacy to reduce the risk of RCC recurrence after nephrectomy. Historically considered a radioresistant tumor, SBRT occupies an expanding role to treat RCC with oligometastasis or oligoprogression in combination with systemic therapy. Furthermore, SBRT is being investigated in combination with ICI-doublet in the advanced disease setting. Lastly, given the treatment paradigm is shifting to adopt ICIs at earlier disease course, the prospective studies guiding treatment sequencing in the post-ICI setting is maturing. The effort is ongoing in search of predictive biomarkers to guide optimal treatment option in RCC.

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State of the Art: Multidisciplinary Management of Oligometastatic Renal Cell Carcinoma

Cited by 11 publications

References 89 publications

Active Surveillance in Metastatic Renal Cell Carcinoma

Active Surveillance in Metastatic Renal Cell Carcinoma

Paradigm Shifting Research: Key Studies in Urologic Oncology

Treatment Landscape of Renal Cell Carcinoma

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