Long-term management of patients with metastatic renal cell carcinoma on targeted agents

Abstract

Therapy for patients with metastatic renal cell carcinoma is becoming increasingly effective. Sustained partial remissions, occasional complete responses and manageable quality of life are seen in a subset of individuals. As we face the prospect of generating an increasingly large number of patients requiring long-term management, the choice and timing of systemic therapy and surgical interventions is becoming increasingly important. In this article, we review the timing and type of cytoreductive nephrectomy, what to do for patients with oligometastatic disease and how to deal with complete responders. In addition, we summarize the major side effects experienced with the commonly used molecularly targeted agents, and provide guidance on how to maximize benefit from these agents while maintaining an acceptable quality of life for patients. As treatment efficacy improves, the optimal integration of systemic therapy, surgery and toxicity management will become a critical aspect of our care for patients with metastatic renal cell carcinoma.

Keywords::

• cancer survivorship
• renal cell carcinoma
• targeted therapy
• therapy complications

Financial & competing interests disclosure

Eric Jonasch has acted as a consultant for Pfizer, Novartis, GSK and Genentech, and received research support from Pfizer, Novartis and GSK. Lance Pagliaro has acted as the principal investigator or co-principal investigator on clinical trials supported by Eli Lilly, Pfizer, sanofi-aventis, Bristol-Myers Sqibb, Millennium Pharmaceuticals and Celgene. Nizar Tannir has served as consultant/advisor to Novartis and Genetech, and has received research support from Pfizer, Novartis, Amgen and Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.