The small-molecule tyrosine kinase (TK) inhibitors bind to receptor TKs (RTKs) located on cell-surface growth factor receptors (GFRs), thereby inhibiting tumor growth. Targeted therapies have been developed to interfere with intracellular signaling, tumor-cell proliferation, differentiation, and angiogenesis. High-dose nonmyeloablative chemotherapy followed by allogeneic stem-cell transplantation remains experimental. Conventional chemotherapy yields response rates of less than 10% and often is used in a palliative context. 3 High-dose IL-2, which was FDA-approved in 1992 for advanced RCC, provides durable complete response in a small fraction of patients. Treatment with these agents alone or in combination yields a median survival of 12 to 17.5 months. 4įor many years, immunotherapy with the biologic response modifiers interleukin-2 (IL-2) and interferon-alpha (IFN-A) has been the mainstay of systemic treatment for metastatic disease. Surgery is a good choice for patients with advanced disease, benefiting quality of life by reducing pain or bleeding, and sometimes even improving survival. Localized disease can be cured with surgery unfortunately, about 30% of these patients will have disease recurrence. Surgery is an important option for patients with RCC. 2 See TABLE 1 for predictors of short survival. A prognostic model to predict survival was developed to stratify patients into low-risk (no risk factors), intermediate-risk (1-2 risk factors), and poor-risk categories (>2 risk factors). Patients with metastatic RCC have an estimated 10% survival rate at 5 years. One genetic abnormality is the mutation of the von Hippel-Lindau tumor-suppressor gene often seen in clear-cell carcinomas. Risk factors include smoking, hypertension, obesity, cystic kidney disease, and genetic abnormalities. The incidence of RCC is increasing, and about 30% of patients present with metastatic disease. The histology is primarily clear cell carcinoma (85%) the remaining 15% comprises papillary, chromophobe, and collecting-duct carcinomas. RCC constitutes 90% of kidney cancers, and the peak incidence is in the sixth decade of life.
The overall lifetime risk of developing kidney cancer is approximately 1 in 75 (1.34%). Kidney cancer is one of the 10 most common types of cancer in men and women, with men at higher risk than women. Included in these statistics are renal cell carcinoma (RCC) and transitional cell carcinoma of the renal pelvis. The American Cancer Society has estimated that 57,760 new cases of kidney cancer and 12,980 deaths due to kidney cancer will occur in the United States in 2009.
0 kommentar(er)
