Question

Management of metastatic RCC.

Hint:

Immune checkpoint inhibitors and targeted therapies have significantly improved the prognosis for patients with metastatic RCC.

Answer 1

Renal cell carcinoma (RCC) is a malignancy of the kidney that can metastasize to various organs. The management of metastatic RCC (mRCC) requires a multi-disciplinary approach, involving systemic therapies, targeted therapies, and sometimes surgical intervention.
Step 1: Systemic Therapy:
The mainstay of treatment for mRCC includes targeted therapies, such as tyrosine kinase inhibitors (TKIs) like sunitinib and pazopanib, and immune checkpoint inhibitors like nivolumab and pembrolizumab. These therapies work by inhibiting angiogenesis and promoting immune-mediated tumor destruction.
Step 2: Immunotherapy:
Immunotherapy has become a cornerstone in the management of mRCC. Combination therapies, such as nivolumab and ipilimumab, have shown improved survival rates in patients with mRCC by enhancing the body's immune response to the tumor.
Step 3: Surgical Management:
Surgical resection of metastatic lesions may be considered in select patients, especially if they have a limited number of metastatic sites. Nephrectomy (removal of the primary tumor) is also part of the management for certain patients.