Recent Updates in Treatment of Renal Cell Carcinoma – A Comprehensive Review

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The incidence and prevalence of Renal cell carcinoma (RCC) continues to grow making it the 7th and 8th most common cancer among men and women in the U.S. respectively. Loss or mutation of VHL (Von-Hippael Lindau) gene is yet known major cause of the development of RCC. This mutation or loss of VHL gene causes increased expression and production of hypoxia-inducible factors and various other pro-angiogenic growth factors following which the neoangiogenes occurs ultimately causing the development of cancer. RCC is a unique malignancy as it considerably causes host immune dysfunction. Multimodality paradigm of treatment of metastatic RCC broadly includes surgical approaches and adjuvant therapy. Anti-cancer market has seen the emergence of other neoadjuvant approaches like the targeted therapy and has prolonged the survival in the past years. The evidence of the reduced effectiveness gained from the cytokines where the primary tumor did not respond well and the spontaneous regression of metastases following nephrectomy drew attention on the use of targeted VEGF (TKI) therapy. These drugs induce tumor shrinkage by blocking the angiogenesis of the tumor cells. Pre-operative treatment with targeted therapy can affect the overall quality of life by reducing tumor bulk prior to surgery. Such an intervention can save the patient from invasive surgical approaches and render unresectable disease as “resectable’. Sunitinib has now become a first line therapy. Biologics like monoclonal antibodies are also showing therapeutic effectiveness. Axitinib being the 2nd line drug has been approved for the treatment after failure of 1st line sunitinib therapy. Other mechanisms like m TOR inhibition being used as 3rd line therapy and are an active area of health service research. This review highlights the recent updates in the palliation and treatment modalities of advanced RCC and the emergence of various checkpoint inhibitors as potential future trends for the treatment.