Oxford Case Histories in Oncology by Unknown

Author:Unknown [Unknown]
Language: eng
Format: epub
Publisher: Oxford University Press, USA
Published: 2014-02-13T00:00:00+00:00

Nine months after the second surgery, a routine CT scan revealed mediastinal lymph nodes, measuring 40, 21, and 24mm (Fig. 15.3). The patient declined a biopsy.

Fig. 15.3

Question

6. What therapy would you recommend?

Answer

6. What therapy would you recommend?

The treatment strategy for ChRCC is not well defined. The evidence of overexpression of VEGF and CD117 in ChRCC suggests a potential role for targeted therapies, but the reported data concerning the efficacy of TKIs in ChRCC are derived from retrospective analyses and expanded access trials.

The majority of clinical trials in metastatic RCC focus on patients with predominantly clear cell histology. The trial results rarely report differences in outcome between clear and non-clear cell types after TKI treatment, and therefore very little is known about the therapeutic benefit of TKIs in patients with non-clear cell RCC histology. However, the expanded-access trials of sunitinib and sorafenib included a considerable number of patients with non-clear cell histology and showed clinical efficacy of these agents in this type of RCC. Even though inhibitors of VEGF and mTOR pathways have been shown to have significant clinical benefit in advanced RCC, the role of these agents in patients with ChRCC remains unclear. Thus, the treatment options for this patient include sunitinib and sorafenib.

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