International Medical Journal, Vol. 20., Iss. 2, 2014, P. 87−89.
CONTEMPORARY VIEWS ON THE PROBLEM OF METASTATIC KIDNEY CANCER
Kharkiv Medical Academy of Postgraduate Education
The percentage of renal tumors equals 2 % among all malignant tumors in adults. The treatment tactics in renal cell cancer patients (60−80 % of all histology types) not long ago included only surgical treatment with further cytokine prescription. Patients with metastatic renal cell cancer make 30 % of all the patients with this pathology. This is the most complicated contingent that requires individual approach. Prescription of distant gamma therapy and polychemotherapy had no success because of tumor resistance towards those methods. The usage of interferon−2? in combination with interleukin−2 had little effectiveness with great number of side effects. Remissions with immunotherapy were observed only in 7−8 %. The effectiveness of metastatic renal cell cancer treatment enhanced greatly since introduction of targeted agents in clinical application. As the first−line therapy the patients are offered cytoreductive nephrectomy with further interferon or targeted therapy, which is more acceptable. As the first−line therapy we choose sunitinib, sorafenib or pazopanib. The second−line therapy is represented with everolimus or temsirolimus. Thus, when ineffective, one targeted agent could be changed to another, or prescribed with interferon for better effect. The choice of the drug is based on MSKCC criteria and the factors of the tumor process visualization (CT, MRI, US). Additional selection criteria for a target drug as well as treatment control are under development.
Key words: clear−cell kidney cancer, metastatic kidney cancer, target therapy, cytoreductive nephrectomy.