Download - ADVANCES IN THE TREATMENT OF RENAL CANCER
ADRENAL
TUMOUR
KIDNEY
ADRENAL ADRENAL
ADRENAL ADRENAL
IVC
TUMOUR
GEROTA FASCIA
TUMOUR
KIDNEY
STAGE I STAGE II
STAGE III STAGE III
Confined to kidney and
<7cm in size
Confined to kidney and > 7cm in size
Involvement of vessels/adrena
l. NOT extending
beyond Gerota’s fascia
STAG
ING
SURGICAL MANAGEMENT
RADICAL NEPHRECTOMY
PARTIAL NEPHRECTOMY
CYTOREDUCTIVE NEPHRECTOMY
PALLIATIVE SURGERY
IMMUNOTHERAPY
MOLECULAR TARGETED AGENTS
RADIOTHERAPY
ADJUVANT THERAPY ?
TRIALS ARE CONTINUING
CHEMOTHERAPY
CHEMOTHERAPY EFFICACIOUS IN TUMOURS WITH
SARCOMATOID DIFFERENTIATION.
IMMUNOTHERAPY
IMMUNOTHERAPY
IL-2 IFN - α
GOOD PERFORMANCE STATUS.INTACT CARDIOPULMONARY
RESERVE.SIGNIFICANT TOXICITY.
ANTI-ANGIOGENESIS PATHWAY
MOLECULARLY TARGETED THERAPY
TYROSINE KINASE INHIBITORS
SUNITINIB SORAFENIB PAZOPANIB
HYPERTENSION
MOLECULARLY TARGETED THERAPY
mTOR
CELL PROLIFERATION
CELL METABOLISM
ANGIOGENESIS
PROTEIN SYNTHESIS
mTOR INHIBITORS
CELL MEMBRANCE
PTENPI3K
AKT
IMMUNOTHERAPY
TYROSINE KINASE INHIBITORS (TKI)
mTOR INHIBITORS
SECOND TKI
SEQUENTIAL THERAPY
FOR SELECT PATIENTS
NEPHRON SPARING
TECHNIQUES
ACTIVE SURVEILLANCE
OTHER OPTIONS
TUMOURS < 4 cm IN PTS WITH
SIGNIFICANT COMORBIDITIES
ENUCLEATION
THERMAL ABLATION
RADIOTHERAPY
• Effective palliative tool
• Stereotactic radiosurgery
CLINICAL TRIALS
TEMSIROLIMUS
TYROSINE KINASE
INHIBITORS
NON CLEAR CELL DISEASE
FUTURE STRATEGIES
• New systemic treatments for advanced RCC
• No established role of adjuvant therapy.
• Future therapeutic options.
SUMMARY