Hydroxyurea is NOT Used to Treat Renal Cell Carcinoma
Hydroxyurea has no role in the modern treatment of renal cell carcinoma and is not recommended by any current clinical practice guidelines. 1, 2
Current Standard Treatment for Metastatic RCC
The established first-line treatments for metastatic renal cell carcinoma are:
- For intermediate and poor-risk patients: Nivolumab plus ipilimumab (immune checkpoint inhibitors) 2
- For good and intermediate-risk patients: VEGF-targeted agents including sunitinib, pazopanib, or bevacizumab plus interferon 1, 2
- For poor-prognosis patients: Temsirolimus (mTOR inhibitor) 1
Why Hydroxyurea Is Not Used
Renal cell carcinoma is highly resistant to systemic chemotherapy, and no chemotherapy agent should be considered standard treatment for metastatic disease. 3 The multiple ESMO Clinical Practice Guidelines for RCC from 2012,2014, and 2019 make no mention of hydroxyurea as a treatment option for any stage of renal cell carcinoma. 1
Historical Context Only
While one small phase II study from 1978 reported responses in 5 of 8 patients using a combination regimen that included hydroxyurea with adriamycin, vinblastine, and medroxyprogesterone acetate, this approach was never validated or adopted into clinical practice. 4 The median survival in that study was only 4 months, and this combination therapy has been completely superseded by modern targeted therapies and immunotherapies. 4
Common Pitfall to Avoid
Do not confuse hydroxyurea's established role in sickle cell disease and certain myeloproliferative disorders with any indication for renal cell carcinoma. 1, 5, 6 Hydroxyurea inhibits ribonucleotide reductase and has legitimate uses in other conditions, but RCC's inherent chemoresistance makes it ineffective for this malignancy. 5, 3