Cells (Jun 2024)

First-Line Treatments and Management of Metastatic Renal Cell Carcinoma Patients: An Italian Interdisciplinary Uro-Oncologic Group Algorithm

  • Francesco Bloise,
  • Fiorella Manfredi,
  • Luca Zatteri,
  • Giovanni Dima,
  • Chiara Carli,
  • Rosanna Di Vita,
  • Maria Olivieri,
  • Enrico Sammarco,
  • Marco Ferrari,
  • Alessia Salfi,
  • Adele Bonato,
  • Debora Serafin,
  • Natalia Coccia,
  • Laura Doni,
  • Luca Galli,
  • Michele Sisani,
  • Giandomenico Roviello,
  • Martina Catalano,
  • Federico Paolieri

DOI
https://doi.org/10.3390/cells13110961
Journal volume & issue
Vol. 13, no. 11
p. 961

Abstract

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The treatment landscape for metastatic renal cell carcinoma (mRCC) has undergone significant transformations in recent years. The introduction of novel combination therapies involving tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors has resulted in improved oncological outcomes compared to traditional TKI monotherapy. In this evolving paradigm, the pivotal role of the multidisciplinary tumor board is underscored, particularly in shaping the therapeutic trajectory for patients eligible for locoregional interventions like cytoreductive nephrectomy and metastasectomy. In cases where systemic treatment is deemed appropriate, the absence of direct comparisons among the various combination therapies complicates the selection of a first-line approach. The clinician is faced with the challenge of making decisions based on patient-specific factors such as performance status, risk classification according to the International Metastatic Renal Cell Carcinoma Database Consortium, comorbidities, and disease characteristics, including the number and location of metastases and tumor histology. Considering these concerns, we propose, as a member of a Tuscany Interdisciplinary Uro-Oncologic Group, an algorithm to streamline the decision-making process for mRCC patients, offering guidance to clinicians in their day-to-day clinical practice.

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