Renal cell carcinomas, which arise from the renal cortex, account for 80-85% of primary renal neoplasms. Transitional cell cancers, which begin in the renal pelvis, account for around 8% of all cases. Medullary renal carcinoma is an uncommon but aggressive kind of renal cell cancer identified in sickle cell disease patients.
Papillary, clear cell, and chromophobe cancers are less frequent subtypes. Collecting duct tumors, oncocytomas, renal sarcomas, and angiomyolipomas are uncommon parenchymal epithelial tumors. Nephroblastoma and Wilm’s tumors are prevalent in adolescents.
Epidemiology
Renal cell carcinoma is the most frequent kind of adult renal malignancy. It is more common in men aged 50 to 70. Geographically, the incidence varies, with North America and the Czech Republic having the highest rates. Each year, roughly 63,000 new cases and over 14,000 fatalities occur in the United States.
Renal cell carcinoma incidence rates in the United States have been increasing since the mid-2000s. The majority of the increases during the 1980s have been in early-stage malignancies.
Anatomy
Pathophysiology
The kidney tissue from which carcinoma develops is the proximal renal tubular epithelium. There are two sporadic forms: nonhereditary and hereditary. Both variants have structural changes on the short arm of chromosome 3.
The study of a family at high risk of developing kidney cancer resulted in the cloning of genes. Renal cell carcinoma development was caused by mutations in tumor suppressor genes VHL, TSC, or oncogenes.
Etiology
The precise cause is uncertain. Older age, hypertension, obesity, dialysis therapy, chronic renal failure, polycystic kidney disease, African American race, renal calculi, and sickle cell disease enhance an individual’s chance of developing renal cancer.
Von Hippel-Lindau syndrome and Tuberous sclerosis are inherited illnesses that enhance the risk of renal cell carcinoma. Birt-Hogg-Dube syndrome, hereditary leiomyomatosis, papillary renal carcinoma, and renal cell carcinoma are all inherited conditions.
Many studies have revealed that exposure to specific drugs in the workplace increases the risk. These chemicals include cadmium, trichloroethylene, herbicides, and asbestos.
Genetics
Prognostic Factors
Due to early diagnosis and treatment, the death rate from this cancer has decreased during the last two decades. Five-year survival rates for stage 1 cancer exceed 90%, and for stage 2 kidney carcinoma, 79%.
Over five years, the survival rate for patients with involvement of lymph nodes reduces to fewer than 40%. Obesity, high-performance status, complete primary excision, and a prolonged disease-free gap from the surgical procedure to the appearance of metastases are all related to increased survival.
Patients with a genetic history should be counseled about the need to screen additional family members.
usual dose: 5.5-7.4 mg per m2 IV once every 7 days
Max: 18.5 mg per m2 once every seven days
The patient should not take a high dose if the white cell count reduces to 3000 cells per mm3
every 12 hrs in combination with avelumab, increase to 7 mg after 2 weeks toleration.
Reduce the dose to 3-2 mg if adverse effects appear.
5 mg twice a day every 12 hrs, in combination with pembrolizumab, increase to 7 mg after 6 weeks of toleration.
Reduce the dose to 3-2 mg if adverse effects appear.
Second-line therapy:
5 mg twice a day every 12 hrs, increase to 7 mg after 6 weeks of tolerance. Reduce the dose to 3-2 mg if adverse effects appear.
the total duration of therapy is continued until disease progression, or no toxicity occurs
Note:
Tablets need to be swallowed with a glass of water but do not chew, crush, or break the tablet
Do not combine the brands of Afinitor tablets and Afinitor Disperz to reach the desired dose
Only use any one of them
The treatment needs to be continued until disease progression or unacceptable toxicity occurs
when given with a combination of nivolumab
40 mg given orally once a day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs
ipilimumab 1 mg per kg given IV over 30 minutes every 3 weeks with nivolumab 3 mg per kg given IV over 30 minutes on the same day for 4 doses
After completing four doses of combination, nivolumab is given as a single agent
Continue the treatment until disease progression or unacceptable toxicity occurs
Indicated in combination with cabozantinib for the first-line treatment of RCC advanced renal cell carcinoma
240 mg intravenously every 2 weeks or 480 mg intravenously every 4 weeks plus 40 mg cabozantinib orally each day
nivolumab, continue until the unacceptable toxicity or disease progression up to 2 years
cabozantinib, continue until disease progression or unacceptable toxicity
Combination with ipilimumab
Indicated for patients with a risk of previously untreated advanced renal cell carcinoma 3 mg/kg nivolumab intravenously every 3 weeks with 1 mg/kg ipilimumab intravenously on the same day as 4 doses
After 4 doses, administer nivolumab 240 mg intravenously every 2 weeks or 480 mg intravenously every 4 weeks
Continue until the unacceptable toxicity or disease progression
Combination therapy with everolimus:
lenvatinib- 18 mg (one 10 mg capsule plus two 4 mg capsules) orally each day, with everolimus- 5 mg orally each day
Combination therapy with pembrolizumab:
lenvatinib- 20 mg orally each day, with pembrolizumab 200 mg intravenously for 3 weeks or 400 mg every 6 weeks
sunitinib is indicated to treat advanced renal cell carcinoma
A dose of 50 mg orally is administered each day for four weeks
After a gap of two weeks, the same dosage regimen should be repeated
Adjuvant treatment of RCC
sunitinib is indicated for the adjuvant treatment of adult patients at high risk of recurrent RCC following nephrectomy
50 mg orally each day for 4 weeks, keeping 2 weeks drug-free, repeat the cycle for total nine 6-week cycles
pazopanib is indicated to treat renal cell carcinoma
A dose of 800 mg orally, each day, is administered on an empty stomach (1 hour before meals or 2 hours after meals)
The medication is continued until the disease is reduced to acceptable toxicity
Indicated for Metastatic Renal Cell Carcinoma
6 lakh international units/Kg of body weight (0.037 mg/Kg) three times a day intravenously infused over 15 min for highest of 14 doses, after that 9 days rest period; after that highest of 14 extra doses
Retreatment: Assess after four weeks, preferable only if the tumor shrinkage occurs
Metastatic Melanoma
6 lakh international units/Kg of body weight (0.037 mg/Kg) three times a day intravenously infused over 15 min for highest of 14 doses, after that 9 days rest period; after that highest of 14 extra doses
Retreatment: Assess after four weeks, preferable only if the tumor shrinkage occurs
It is also indicated for Non-Hodgkin Lymphoma as an orphan and also for primary immunodeficiency as an orphan
Indicated for Renal Cell Carcinoma
Take 1.34 mg orally once a day on Days 1-21 of each 28-day cycle
In case dose adjustments are necessary due to adverse reactions, lower the dose to 0.89 mg orally once per day for 21 days, after that followed by 7 days off the treatment
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK470336/
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Renal cell carcinomas, which arise from the renal cortex, account for 80-85% of primary renal neoplasms. Transitional cell cancers, which begin in the renal pelvis, account for around 8% of all cases. Medullary renal carcinoma is an uncommon but aggressive kind of renal cell cancer identified in sickle cell disease patients.
Papillary, clear cell, and chromophobe cancers are less frequent subtypes. Collecting duct tumors, oncocytomas, renal sarcomas, and angiomyolipomas are uncommon parenchymal epithelial tumors. Nephroblastoma and Wilm’s tumors are prevalent in adolescents.
Renal cell carcinoma is the most frequent kind of adult renal malignancy. It is more common in men aged 50 to 70. Geographically, the incidence varies, with North America and the Czech Republic having the highest rates. Each year, roughly 63,000 new cases and over 14,000 fatalities occur in the United States.
Renal cell carcinoma incidence rates in the United States have been increasing since the mid-2000s. The majority of the increases during the 1980s have been in early-stage malignancies.
The kidney tissue from which carcinoma develops is the proximal renal tubular epithelium. There are two sporadic forms: nonhereditary and hereditary. Both variants have structural changes on the short arm of chromosome 3.
The study of a family at high risk of developing kidney cancer resulted in the cloning of genes. Renal cell carcinoma development was caused by mutations in tumor suppressor genes VHL, TSC, or oncogenes.
The precise cause is uncertain. Older age, hypertension, obesity, dialysis therapy, chronic renal failure, polycystic kidney disease, African American race, renal calculi, and sickle cell disease enhance an individual’s chance of developing renal cancer.
Von Hippel-Lindau syndrome and Tuberous sclerosis are inherited illnesses that enhance the risk of renal cell carcinoma. Birt-Hogg-Dube syndrome, hereditary leiomyomatosis, papillary renal carcinoma, and renal cell carcinoma are all inherited conditions.
Many studies have revealed that exposure to specific drugs in the workplace increases the risk. These chemicals include cadmium, trichloroethylene, herbicides, and asbestos.
Due to early diagnosis and treatment, the death rate from this cancer has decreased during the last two decades. Five-year survival rates for stage 1 cancer exceed 90%, and for stage 2 kidney carcinoma, 79%.
Over five years, the survival rate for patients with involvement of lymph nodes reduces to fewer than 40%. Obesity, high-performance status, complete primary excision, and a prolonged disease-free gap from the surgical procedure to the appearance of metastases are all related to increased survival.
Patients with a genetic history should be counseled about the need to screen additional family members.
usual dose: 5.5-7.4 mg per m2 IV once every 7 days
Max: 18.5 mg per m2 once every seven days
The patient should not take a high dose if the white cell count reduces to 3000 cells per mm3
every 12 hrs in combination with avelumab, increase to 7 mg after 2 weeks toleration.
Reduce the dose to 3-2 mg if adverse effects appear.
5 mg twice a day every 12 hrs, in combination with pembrolizumab, increase to 7 mg after 6 weeks of toleration.
Reduce the dose to 3-2 mg if adverse effects appear.
Second-line therapy:
5 mg twice a day every 12 hrs, increase to 7 mg after 6 weeks of tolerance. Reduce the dose to 3-2 mg if adverse effects appear.
the total duration of therapy is continued until disease progression, or no toxicity occurs
Note:
Tablets need to be swallowed with a glass of water but do not chew, crush, or break the tablet
Do not combine the brands of Afinitor tablets and Afinitor Disperz to reach the desired dose
Only use any one of them
The treatment needs to be continued until disease progression or unacceptable toxicity occurs
when given with a combination of nivolumab
40 mg given orally once a day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs
ipilimumab 1 mg per kg given IV over 30 minutes every 3 weeks with nivolumab 3 mg per kg given IV over 30 minutes on the same day for 4 doses
After completing four doses of combination, nivolumab is given as a single agent
Continue the treatment until disease progression or unacceptable toxicity occurs
Indicated in combination with cabozantinib for the first-line treatment of RCC advanced renal cell carcinoma
240 mg intravenously every 2 weeks or 480 mg intravenously every 4 weeks plus 40 mg cabozantinib orally each day
nivolumab, continue until the unacceptable toxicity or disease progression up to 2 years
cabozantinib, continue until disease progression or unacceptable toxicity
Combination with ipilimumab
Indicated for patients with a risk of previously untreated advanced renal cell carcinoma 3 mg/kg nivolumab intravenously every 3 weeks with 1 mg/kg ipilimumab intravenously on the same day as 4 doses
After 4 doses, administer nivolumab 240 mg intravenously every 2 weeks or 480 mg intravenously every 4 weeks
Continue until the unacceptable toxicity or disease progression
Combination therapy with everolimus:
lenvatinib- 18 mg (one 10 mg capsule plus two 4 mg capsules) orally each day, with everolimus- 5 mg orally each day
Combination therapy with pembrolizumab:
lenvatinib- 20 mg orally each day, with pembrolizumab 200 mg intravenously for 3 weeks or 400 mg every 6 weeks
sunitinib is indicated to treat advanced renal cell carcinoma
A dose of 50 mg orally is administered each day for four weeks
After a gap of two weeks, the same dosage regimen should be repeated
Adjuvant treatment of RCC
sunitinib is indicated for the adjuvant treatment of adult patients at high risk of recurrent RCC following nephrectomy
50 mg orally each day for 4 weeks, keeping 2 weeks drug-free, repeat the cycle for total nine 6-week cycles
pazopanib is indicated to treat renal cell carcinoma
A dose of 800 mg orally, each day, is administered on an empty stomach (1 hour before meals or 2 hours after meals)
The medication is continued until the disease is reduced to acceptable toxicity
Indicated for Metastatic Renal Cell Carcinoma
6 lakh international units/Kg of body weight (0.037 mg/Kg) three times a day intravenously infused over 15 min for highest of 14 doses, after that 9 days rest period; after that highest of 14 extra doses
Retreatment: Assess after four weeks, preferable only if the tumor shrinkage occurs
Metastatic Melanoma
6 lakh international units/Kg of body weight (0.037 mg/Kg) three times a day intravenously infused over 15 min for highest of 14 doses, after that 9 days rest period; after that highest of 14 extra doses
Retreatment: Assess after four weeks, preferable only if the tumor shrinkage occurs
It is also indicated for Non-Hodgkin Lymphoma as an orphan and also for primary immunodeficiency as an orphan
Indicated for Renal Cell Carcinoma
Take 1.34 mg orally once a day on Days 1-21 of each 28-day cycle
In case dose adjustments are necessary due to adverse reactions, lower the dose to 0.89 mg orally once per day for 21 days, after that followed by 7 days off the treatment
https://www.ncbi.nlm.nih.gov/books/NBK470336/
medtigo
Renal Cell Carcinoma
Updated :
October 21, 2022
Renal cell carcinomas, which arise from the renal cortex, account for 80-85% of primary renal neoplasms. Transitional cell cancers, which begin in the renal pelvis, account for around 8% of all cases. Medullary renal carcinoma is an uncommon but aggressive kind of renal cell cancer identified in sickle cell disease patients.
Papillary, clear cell, and chromophobe cancers are less frequent subtypes. Collecting duct tumors, oncocytomas, renal sarcomas, and angiomyolipomas are uncommon parenchymal epithelial tumors. Nephroblastoma and Wilm’s tumors are prevalent in adolescents.
Renal cell carcinoma is the most frequent kind of adult renal malignancy. It is more common in men aged 50 to 70. Geographically, the incidence varies, with North America and the Czech Republic having the highest rates. Each year, roughly 63,000 new cases and over 14,000 fatalities occur in the United States.
Renal cell carcinoma incidence rates in the United States have been increasing since the mid-2000s. The majority of the increases during the 1980s have been in early-stage malignancies.
The kidney tissue from which carcinoma develops is the proximal renal tubular epithelium. There are two sporadic forms: nonhereditary and hereditary. Both variants have structural changes on the short arm of chromosome 3.
The study of a family at high risk of developing kidney cancer resulted in the cloning of genes. Renal cell carcinoma development was caused by mutations in tumor suppressor genes VHL, TSC, or oncogenes.
The precise cause is uncertain. Older age, hypertension, obesity, dialysis therapy, chronic renal failure, polycystic kidney disease, African American race, renal calculi, and sickle cell disease enhance an individual’s chance of developing renal cancer.
Von Hippel-Lindau syndrome and Tuberous sclerosis are inherited illnesses that enhance the risk of renal cell carcinoma. Birt-Hogg-Dube syndrome, hereditary leiomyomatosis, papillary renal carcinoma, and renal cell carcinoma are all inherited conditions.
Many studies have revealed that exposure to specific drugs in the workplace increases the risk. These chemicals include cadmium, trichloroethylene, herbicides, and asbestos.
Due to early diagnosis and treatment, the death rate from this cancer has decreased during the last two decades. Five-year survival rates for stage 1 cancer exceed 90%, and for stage 2 kidney carcinoma, 79%.
Over five years, the survival rate for patients with involvement of lymph nodes reduces to fewer than 40%. Obesity, high-performance status, complete primary excision, and a prolonged disease-free gap from the surgical procedure to the appearance of metastases are all related to increased survival.
Patients with a genetic history should be counseled about the need to screen additional family members.
https://www.ncbi.nlm.nih.gov/books/NBK470336/
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