renal%20cancer
RENAL CANCER

Renal cancer is the disease in which certain tissues of the kidney starts to grow uncontrollably and form a tumor.

It is also called as renal adenocarcinoma or hypernephroma.

Classic triad of symptoms are flank pain, palpable abdominal mass and gross hematuria.

Principles of Therapy

  • To reduce remission
  • To reduce mortality
  • To prevent complications

Pharmacotherapy

Cancer Immunotherapy

Aldesleukin or Interleukin-2

  • Modified form of interleukin-2 produced by recombinant DNA technology
  • Promotes proliferation, differentiation & recruitment of T & B cells, natural killer (NK) cells & thrombocytes
  • Used for treatment of advanced metastatic renal cell carcinoma (RCC)

Cytotoxic Chemotherapy

Axitinib

  • Second-generation, potent tyrosine kinase inhibitor that selectively targets vascular endothelial growth factors (VEGF) 1, 2 & 3 & inhibits angiogenesis, metastasis & tumor growth
  • Used for treatment of advanced or metastatic RCC after failure of 1 prior systemic therapy

Bevacizumab + Interferon

  • Recombinant humanized monoclonal antibody that binds to VEGF that inhibits angiogenesis occuring during the growth of the tumor
  • Based from the AVOREN (phase III) double-blind trial, the addition of Bevacizumab to Interferon-alfa (IFN-α) significantly increases progression-free survival (PFS)
  • Used for treatment of advanced or metastatic RCC

Everolimus

  • Used for treatment of advanced RCC after treatment failure w/ Sorafenib or Sunitinib
  • The RECORD-1 trial results revealed that Everolimus can be safely given to patients w/ previous intolerance to vascular endothelial growth factor receptors-tyrosine kinase inhibitor (VEGFr-TKI) therapy

Pazopanib

  • An oral angiogenesis inhibitor that targets the VEGFR-1, -2, & -3, platelet-derived growth factor receptors (PDGFR-α & -β) & stem cell factor receptor (c-KIT)
  • Used for treatment of advanced or metastatic RCC
  • It is important to monitor the liver function tests (LFTs) before & during treatment w/ Pazopanib

Sorafenib

  • Small molecule that inhibits multiple isoforms of the intracellular serine/threonine kinase, RAF & also other receptor tyrosine kinases, including VEGFR-1, -2, & -3, PDGFR-β, FMS-like tyrosine kinase (FLT-3), c-KIT & neurotrophic factor receptor (RET)
  • Used for treatment of advanced or metastatic RCC

Sunitinib

  • Multikinase inhibitor targeting several tyrosine kinase inhibitors that is implicated in PDGFR-α & -β, VEGFR-1, -2, & -3, FLT-3, colony-stimulating factor (CSF-1R) & (RET)
  • Used for treatment of advanced or metastatic RCC

Temsirolimus

  • Inhibitor of the mammalian target of rapamycin (mTOR) protein
  • Regulates micronutrients, cell growth, apoptosis & angiogenesis by its downstream effects on a variety of proteins
  • Used for treatment of advanced or metastatic RCC

Other medications that can be used for advanced or metastatic RCC

Cabozantinib

  • According to the results of an interim analysis of the Phase III METEOR trial, it has significantly delayed the progression of the disease as compared w/ Everolimus in patients w/ advanced clear cell renal cell carcinoma (ccRCC) w/ prior VEGR-TKI treatment
  • The trial results showed that Cabozantinib was able to shrink the tumors & slow down the tumor growth
  • Also being studied as a potential first-line treatment & is in early trials combining
  • Cabozantinib w/ immune checkpoint inhibitors
  • Can be used as treatment for advanced or metastatic RCC

Nivolumab

  • A human programmed death receptor-1 (PD-1) blocking antibody used in patients who already received angiogenesis inhibitor therapy
  • Can be used as treatment for advanced or metastatic RCC