What is renal cell carcinoma (RCC)?

From the Guidelines

Renal cell carcinoma (RCC) treatment should prioritize surgical resection with curative intent, including radical nephrectomy (RN) or partial nephrectomy (PN), as the standard of care for clinically localized RCC, as stated in the most recent guidelines 1.

Introduction to Renal Cell Carcinoma

RCC accounts for 85% of all malignant renal tumors and represents approximately 2% to 3% of all malignancies in adults 1. It is considered the most lethal of all urologic cancers. Risk factors include smoking, obesity, hypertension, family history, and certain genetic syndromes like von Hippel-Lindau disease.

Diagnosis and Treatment

Diagnosis involves contrast-enhanced CT scans or MRI, with definitive diagnosis requiring histopathological examination. Treatment depends on the stage and may include partial or radical nephrectomy for localized disease, while metastatic RCC may require systemic therapy with targeted agents (sunitinib, pazopanib), immunotherapy (nivolumab, pembrolizumab), or combination approaches 1. Ablative therapies such as radiofrequency ablation, microwave ablation, and cryoablation have been shown to be effective and safe alternatives for the treatment of small localized RCCs 1.

Follow-up and Surveillance

Regular follow-up with imaging and laboratory tests is essential after treatment to monitor for recurrence. The American College of Radiology has published guidelines for the follow-up of patients with treated or untreated RCC, which include the use of radiologic imaging as the most useful component of surveillance 1.

Key Points

• RCC is the most common type of kidney cancer in adults
• Surgical resection with curative intent is the standard of care for clinically localized RCC
• Ablative therapies are effective and safe alternatives for small localized RCCs
• Regular follow-up with imaging and laboratory tests is essential after treatment to monitor for recurrence
• Prognosis varies significantly based on stage at diagnosis, with 5-year survival rates ranging from over 90% for localized disease to less than 15% for metastatic disease 1.

From the Research

Overview of Renal Cell Carcinoma

• Renal cell carcinoma (RCC) is the most common cancer of the kidneys, primarily treated with surgery, including removal of part or all of the involved kidney depending on size, tumor complexity, and patient characteristics 2.
• The incidence of RCC has increased approximately 1% per year from 2015 through 2019, but the mortality rate has declined about 2% per year in the US from 2016 through 2020 3.

Treatment Options for RCC

• Treatment options for RCC confined to the kidney include surgical resection with partial or radical nephrectomy, ablative techniques, or active surveillance for some patients, especially those with renal masses <2 cm 3.
• Partial nephrectomy can result in a 5-year cancer-specific survival of more than 94% for patients with renal masses less than 4 cm in size 3.
• For advanced or metastatic RCC, combinations of immune checkpoint inhibitors or the combination of immune checkpoint inhibitors with tyrosine kinase inhibitors are associated with tumor response of 42% to 71%, with a median overall survival of 46 to 56 months 3.

Emerging Therapies for Metastatic RCC

• There has been significant progress in the treatment of patients with advanced clear cell renal cell carcinoma (ccRCC), with improved knowledge of disease biology and the introduction of targeted agents and immunotherapies 4.
• Current and emerging first-line treatment options include tyrosine kinase inhibitors, such as cabozantinib, and immunotherapy combinations, such as nivolumab/ipilimumab 4.
• Pazopanib has been shown to be effective and well-tolerated in patients with metastatic RCC who have previously received immunotherapy 5 or sunitinib 6.

Real-World Clinical Outcomes

• A real-world study found that pazopanib after immunotherapy was associated with a median progression-free survival of 13.5 months and an estimated overall survival rate of 93% at 6 months and 89% at 12 months 5.
• Another study found that pazopanib after sunitinib failure was associated with a median progression-free survival of 7.4 months and a response rate of 19% 6.