الفهرس 
Diagnosis of Renal Cell Carcinoma (RCCOnly 14 pages are availabe for public view
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Abstract
Renal cell carcinoma (RCC) represents 2-3% of all adult cancers, it is the most common solid malignant lesion within the kidney. Systemic therapy for RCC can be divided into immunotherapy & targeted therapy (angiogenesis inhibitor drugs).
* In localized RCC, radical nephrectomy remains the only curative therapy and offers a reasonable chance of curing the disease. There is a 35–65% recurrence rate in patients with locally aggressive tumors. This subgroup of patients may derive the greatest benefit from systemic therapy. Some evidence suggests that adjuvant systemic therapy might improve the duration of progression-free survival (PFS) in localized RCC patients undergoing surgical treatment.
Immunotherapy remains a basis of promising treatment strategies. Therapeutic vaccines used in treatment of localized RCC are: (1) Autologous tumor cell–based vaccines with reniale as an important example proved to improve the 5-years PFS for high-risk patients at all tumor stages when administered after nephrectomy. (2) Peptide-based vaccines with vitespen as an example which could not significantly improve PFS & requires further validation.
The role of targeted therapies in localized RCC (neoadjuvant or adjuvant therapy) needs to be evaluated in clinical trials. Currently, three randomized, double-blind, phase 3 trials are ongoing to investigate whether adjuvant targeted therapies may kill any tumor cells that remain after surgery in patients with unfavorable RCC or who are at high or intermediate risk of relapse.
*In metastatic RCC, surgery has a vital but limited role and its success is largely dependent on the stage of the disease. Surgical interventions in mRCC can be directed at palliation of symptoms or controlling metastasis.
Immunotherapy, using cytokines & RCC vaccines, remains an important therapeutic option even after the development of novel targeted therapies. The value of immunotherapy is its curative potential in some patients and its capability to obtain durable responses. Cytokines can be of value as adjuvant or neoadjuvant therapies or in combination with chemotherapy. IL-2 can be used for selected patients with good risk profile and clear-cell subtype histology while monotherapy with IFN-alpha can no longer be considered as a first-line treatment for mRCC. RCC vaccines have shown limited clinical efficacy in RCC studies, but there is still interest for the use of them as they have much less toxicity than other current therapies for RCC. Several trials with different types of RCC vaccines are ongoing, and results are still awaited.
Improved understanding of the molecular biology underlying mRCC has led to the development of targeted therapies making a revolution in mRCC therapeutic options. The newly available targeting agents are today the treatment of choice for patients with metastatic clear-cell RCC. The 1st line agents include sunitinib, bevacizumab plus IFN-α & pazopanib, in which they all have demonstrated clinical activity in low and intermediate-risk groups, while temsirolimus has shown activity in a subgroup of high-risk patients.2nd line agents include sorafenib, pazopanib &everolimus.Combination of targeted agents seems to augment their efficacy. Also these agents could achieve a role in non–clear-cell histology subtypes