The adjuvant therapy of high-risk, resected, kidney cancer: From past failures to the hope coming from molecularly targeted agents

Research output: Contribution to journalArticle

Abstract

Recurrence rates as high as 65% after nephrectomy for localized kidney cancer clearly highlight the need for active adjuvant therapies aimed at reducing this risk of relapse in this cancer. To date, several trials that explored the role of radiation therapy, cytokines, chemoimmunotherapy, vaccines, and Thalidomide have failed to improve the outcome of these patients. Only one trial yielded positive results, but it has been highly criticized from a methodological viewpoint, so that, presently, no adjuvant therapy is recommended in kidney cancer. Risk assessment is key to select individuals for future clinical trials and to adequately compare the populations enrolled in previous studies. Recent advances in the mechanistic comprehension of this disease lead to the development of molecularly targeted agents that changed the natural history of metastatic disease; presently, some of these agents (ie, the multikinase inhibitors Sorafenib, Sunitinib, and Pazopanib, as well as the mTOR Everolimus) are under active evaluation as adjuvant treatments. In this review, we are going to critically address patients' selection issues, the results obtained so far within randomized, controlled, phase III trials, and to present the next generation of adjuvant trials with molecularly targeted agents.

Original languageEnglish
JournalEuropean journal of Clinical and Medical Oncology
Volume4
Issue number4
Publication statusPublished - 2012

Fingerprint

Kidney Neoplasms
Recurrence
Thalidomide
Nephrectomy
Patient Selection
Radiotherapy
Therapeutics
Vaccines
Clinical Trials
Cytokines
Population
Neoplasms

Keywords

  • Adjuvant therapy
  • Clinical trials
  • Kidney cancer

ASJC Scopus subject areas

  • Oncology

Cite this

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title = "The adjuvant therapy of high-risk, resected, kidney cancer: From past failures to the hope coming from molecularly targeted agents",
abstract = "Recurrence rates as high as 65{\%} after nephrectomy for localized kidney cancer clearly highlight the need for active adjuvant therapies aimed at reducing this risk of relapse in this cancer. To date, several trials that explored the role of radiation therapy, cytokines, chemoimmunotherapy, vaccines, and Thalidomide have failed to improve the outcome of these patients. Only one trial yielded positive results, but it has been highly criticized from a methodological viewpoint, so that, presently, no adjuvant therapy is recommended in kidney cancer. Risk assessment is key to select individuals for future clinical trials and to adequately compare the populations enrolled in previous studies. Recent advances in the mechanistic comprehension of this disease lead to the development of molecularly targeted agents that changed the natural history of metastatic disease; presently, some of these agents (ie, the multikinase inhibitors Sorafenib, Sunitinib, and Pazopanib, as well as the mTOR Everolimus) are under active evaluation as adjuvant treatments. In this review, we are going to critically address patients' selection issues, the results obtained so far within randomized, controlled, phase III trials, and to present the next generation of adjuvant trials with molecularly targeted agents.",
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AU - Porta, Camillo

AU - Paglino, Chiara

AU - Masini, Cristina

AU - Sabbatini, Roberto

PY - 2012

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N2 - Recurrence rates as high as 65% after nephrectomy for localized kidney cancer clearly highlight the need for active adjuvant therapies aimed at reducing this risk of relapse in this cancer. To date, several trials that explored the role of radiation therapy, cytokines, chemoimmunotherapy, vaccines, and Thalidomide have failed to improve the outcome of these patients. Only one trial yielded positive results, but it has been highly criticized from a methodological viewpoint, so that, presently, no adjuvant therapy is recommended in kidney cancer. Risk assessment is key to select individuals for future clinical trials and to adequately compare the populations enrolled in previous studies. Recent advances in the mechanistic comprehension of this disease lead to the development of molecularly targeted agents that changed the natural history of metastatic disease; presently, some of these agents (ie, the multikinase inhibitors Sorafenib, Sunitinib, and Pazopanib, as well as the mTOR Everolimus) are under active evaluation as adjuvant treatments. In this review, we are going to critically address patients' selection issues, the results obtained so far within randomized, controlled, phase III trials, and to present the next generation of adjuvant trials with molecularly targeted agents.

AB - Recurrence rates as high as 65% after nephrectomy for localized kidney cancer clearly highlight the need for active adjuvant therapies aimed at reducing this risk of relapse in this cancer. To date, several trials that explored the role of radiation therapy, cytokines, chemoimmunotherapy, vaccines, and Thalidomide have failed to improve the outcome of these patients. Only one trial yielded positive results, but it has been highly criticized from a methodological viewpoint, so that, presently, no adjuvant therapy is recommended in kidney cancer. Risk assessment is key to select individuals for future clinical trials and to adequately compare the populations enrolled in previous studies. Recent advances in the mechanistic comprehension of this disease lead to the development of molecularly targeted agents that changed the natural history of metastatic disease; presently, some of these agents (ie, the multikinase inhibitors Sorafenib, Sunitinib, and Pazopanib, as well as the mTOR Everolimus) are under active evaluation as adjuvant treatments. In this review, we are going to critically address patients' selection issues, the results obtained so far within randomized, controlled, phase III trials, and to present the next generation of adjuvant trials with molecularly targeted agents.

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