Cancer of the Kidney
Summary of Key Points
• Renal cell carcinoma (RCC) accounts for 3% of malignancies in adults.
• Cigarette smoking (in more than 20% of cases) and obesity (in more than 30%) are established causal factors for RCC.
• Four percent of cases of RCC arise from hereditary syndromes.
• Different subtypes of RCC are characterized by distinct clinical behavior, genetic abnormalities, and molecular signatures.
• Clear cell RCC is the most common histologic subtype, representing approximately 70% of all sporadic RCCs.
• The von Hippel-Lindau tumor suppressor gene is genetically and epigenetically altered in more than 75% of sporadic cases of clear cell RCC.
• Prognosis for RCC is dependent on tumor histologic type, grade, and stage.
• Nephron-sparing surgery has become the gold standard, when feasible.
• Follow-up guidelines for resected RCC include history, physical examination, periodic metabolic panels, and abdominal and chest computed tomography (CT) studies 4 to 6 months after surgery.
• High-dose bolus interleukin-2 (IL-2), though toxic and of limited use in selected patients, remains a therapeutic option for clear cell RCC because of its potential for durable complete response. Additional immunotherapeutic approaches under development and promising results have been reported with the immunocheckpoint inhibitor PD-1 antibody. Identification of predictors of response to immunotherapies is undergoing.
• Antiangiogenesis drugs have become the new standard of care in the first-line setting for clear cell RCC. Clinical benefit has also been shown with vascular endothelial growth factor and mammalian target of rapamycin inhibitors in subsequent lines of therapies. Novel targets for therapeutic interventions have been identified and are being exploited in clinical testing.
• Optimal treatment for non–clear cell RCC remains a challenge because of the genetic differences and little knowledge of the dysregulated molecular biology driving these cancers. Rational preclinical and clinical testing is needed.
1. Recent studies show that genes related to chromatin remodeling are commonly mutated in RCC. All of the following are altered in clear cell RCC except:
2. The treatment options for clear cell RCC have significantly increased over past years. The following drugs are acceptable therapies in first-line setting except:
3. Drugs targeting different pathways are currently available for the treatment of kidney cancer. Which of the following statements is the most accurate?
A Sequential therapies with VEGF and mTOR inhibitors remain the current standard of care for the treatment of advanced kidney cancer.
B Combinations of VEGF and mTOR inhibitors have been shown to be relatively well tolerated.
C Combination of immunotherapies and anti-VEGF therapies has increased overall survival in clinical testing.
D Adjuvant treatment with a VEGF inhibitor is standard of care in patients with high-risk disease.
E The doxorubicin + gemcitabine regimen is a valid therapeutic option when VEGF inhibitors fail.
