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World J Nephrol. May 6, 2015; 4(2): 254-262
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.254
Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma?
Adrian Husillos Alonso, Manuel Carbonero García, Carmen González Enguita
Adrian Husillos Alonso, Manuel Carbonero García, Carmen González Enguita, Servicio de Urología, Hospital Universitario Infanta Elena (HUIE), 28340 Valdemoro, Madrid, Spain
Author contributions: Husillos Alonso A designed, performed, analyzed data and wote the paper; Carbonero García M and González Enguita C contributed equally to the writing of the manuscript and designing the aim of the review.
Conflict-of-interest: The authors declared no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adrian Husillos Alonso, MD, Servicio de Urología, Hospital Universitario Infanta Elena (HUIE), Avda. Reyes Católicos 21, 28340 Valdemoro, Madrid, Spain. adrian.husillos@idcsalud.es
Telephone: +34-91-8948410 Fax: +34-91-8948544
Received: November 28, 2014
Peer-review started: November 29, 2014
First decision: December 12, 2014
Revised: January 18, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 6, 2015
Abstract

Metastatic renal cell carcinoma (mRCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival (ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with mRCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it’s based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with long-term survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.

Keywords: Metastatic renal cell carcinoma, Targeted therapy, Metastasectomy, Surgery, Adjuvant treatment

Core tip: We have made a search in Pubmed database looking for evidence to support adjuvant systemic therapy after metastasectomy in metastatic renal cell carcinoma. As far as we know, evidence is low and it’s based in case reports and small series of patients. Despite the limitations and high risk of bias, promising results and cases with long-term survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.