Targeted therapy in renal cell carcinoma
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Purpose of review A better understanding of renal cell carcinoma biology has led to a new era of targeted therapy in the management of metastatic renal cell carcinoma. Recent findings New phase II and phase III clinical data on both Food and Drug Administration approved and investigational targeted agents are now available, widening the choice of therapies in the treatment of metastatic renal cell carcinoma. Summary We provide a review of the data to facilitate effective evidence-based clinical practice and also aim to give a perspective for future clinical and translational research in renal cell carcinoma.Keywords:
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Targeted therapy has favorably changed the standard of care for patients with advanced renal cell carcinoma. However, combinations of targeted therapy have been characterized by excessive toxicity, as exemplified in the report by Molina et al in this issue.
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Renal cell carcinoma(RCC)is one of the most common malignant urinary tumors.Molecular targeted therapy is a way that can inhibit tumor growth by specific cellular pathway.Also,it is better than traditional cytokine therapy.However,effective ways for determing the outcome of targeted therapy are still insufficient.In this review,prognostic related factors of targeted therapy in renal cell carcinoma were summarized referred to the current study.
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Abjective To evaluate the initial therapeutic effect of sorafenib for metastatic renal cell carcinoma.Methods The patient with metastatic renal cell carcinoma was taken sorafenib,at the dosage of 400 mg,two times per day.Results The metastatic tumor volume of 4 cases with advanced renal cell carcinoma significantly decreased(PR),and 1 dispeared completely(CR),1 progressed moderately after 3 months(SD).Conclusion Sorafenib can suppress tumor growth efficiently in metastatic renal cell carcinoma,postpone its progression,and show the major benefit for these patient′s survival.
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Renal cell carcinoma(RCC) is a highly malignant tumor in the urinary system.Radical surgery is the main therapeutic method for the early stage of RCC,but the therapeutic efficacy in advanced or metastatic RCC is not satisfied.As the development of molecular biology,the targeted therapy against RCC achieves a new progress.This review aims to make a summary about molecular basis and new progress of targeted therapy in recent years on advanced clear cell and non-clear cell RCC.
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Purpose of review A better understanding of renal cell carcinoma biology has led to a new era of targeted therapy in the management of metastatic renal cell carcinoma. Recent findings New phase II and phase III clinical data on both Food and Drug Administration approved and investigational targeted agents are now available, widening the choice of therapies in the treatment of metastatic renal cell carcinoma. Summary We provide a review of the data to facilitate effective evidence-based clinical practice and also aim to give a perspective for future clinical and translational research in renal cell carcinoma.
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Translational Research
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Renal cell carcinoma (RCC) with rhabdoid features is an uncommon and highly aggressive malignancy. We report a case of adult clear-cell RCC with extensive rhabdoid features treated with the tyrosine kinase inhibitor sorafenib. A review of the literature summarizes important aspects of this malignancy. We discuss clinical and histological findings as well as the patient’s response to sorafenib therapy.
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Objective To explore the efficacies and adverse events of sorafenib in the treatment of advanced metastatic renal cell carcinoma.Methods A total of 57 patients with advanced kidney cancer were recruited from our hospital from April 2007 to October 2011.They were divided into sorafenib group (A,n=24) and sorafenib+
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What's known on the subject? and What does the study add? Targeted agents with a similar or different target molecule are often used sequentially in the treatment of metastatic RCC. Two tyrosine kinase inhibitors, sorafenib and sunitinib, have been reported to show little cross-resistance, when used sequentially. In addition, a recent report showed that sunitinib rechallenge could potentially benefit selected patients. This case series shows that patients once refractory to sorafenib could regain disease control on rechallenge with sorafenib during sequential treatment. Outcomes of the sorafenib rechallenge were not significantly affected by the response to the initial sorafenib treatment or by the duration of intervening treatments between first sorafenib and rechallenge.To investigate clinical outcomes of sorafenib rechallenge during sequential therapy for patients with metastatic renal cell carcinoma (RCC).Patients with metastatic RCC who received sorafenib rechallenge after failed treatment first with sorafenib and subsequently with other agents, were retrospectively reviewed for patient characteristics, best response, progression-free survival (PFS), and adverse events (AEs).Of the 14 patients who received sorafenib rechallenge, 12 were evaluable for response. Eleven patients had previously undergone nephrectomy, and 10 had previously received systemic therapy, mostly interferon-α (nine patients) and interleukin-2 (six patients), with a median duration of 9 months. The best responses after the first sorafenib therapy were partial response (PR) in two patients, stable disease (SD) in seven, and progressive disease (PD) in two. The median PFS was 5.7 months. Initial sorafenib therapy was discontinued because of PD in eight patients and AEs in four patients. Rechallenge with sorafenib was undertaken after a 7.6 month median interval from the initial sorafenib challenge. Eight patients achieved SD on sorafenib rechallenge and median PFS was 5.4 (95% confidence interval, 3.8-7.0) months. The outcome of the sorafenib rechallenge was not significantly affected by the response to the initial sorafenib treatment or by the duration of treatments received between first sorafenib and rechallenge. No severe AE was newly observed on the rechallenge.In the systemic treatment of advanced RCC, it was suggested that patients once refractory to sorafenib could regain disease control on rechallenge with sorafenib during sequential treatment.
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Renal cell carcinoma is the most common malignant disease which is insensitive to radiotherapy,chemotherapy and radical surgery that was the main treatment for kidney cancer in the past. Since sorafenib was as the first one of the advent of targeted drugs for metastatic renal cell carcinoma, more and more targeted drugs have been researched and applied in clinic and achieved great success. This article introduces the clinical efficacy, adverse reactions, drug-drug combination and sequential use of targeted therapy for the renal cell carcinoma.
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