Research into the biological mechanisms underlying kidney cancer is vital if progress in developing new treatments is to be made.
Since 2004, there have been substantial advances in the treatment of renal cancer. However, surgery (radical or partial nephrectomy) remains the only cure for renal cancer that is detected and diagnosed in the early stages. Targeted surgical techniques, such as cryotherapy and radiofrequency ablation, which reduce the burden on the patient and the NHS by shortening recovery times, have been developed and tested for the treatment of renal carcinomas. These techniques are still experimental and more experience is required before renal surgeons generally accept them.
Although most patients still undergo surgery to remove the kidney, approximately per cent of patients present with advanced disease that cannot be cured by surgery alone, and alternative treatment approaches need to be found.
Kidney cancer is very resistant to conventional chemotherapy and radiotherapy, so new, more powerful and more targeted agents need to be developed and tested in the clinic.
Immunotherapy has been around since 1984, but it is a non-specific and fairly toxic treatment for advanced renal cancer. Since 2004, a number of new biological therapies offering targeted treatment for advanced renal cancer have been developed; sunitinib (Sutent®) and sorafenib (Nexavar®) were launched in 2004, and by the year 2010 axitinib, bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus (Afinitor ®), pazopanib (Votrient®) and cediranib were either available on the market or in late stage development pending marketing authorisation. However, even with these new advances in drug development, there remain a number of challenges for medical oncologists treating patients with renal cell carcinoma (RCC):
Which is the best first-line therapy?
Can treatment be individualised, as is the case for breast cancer?
What is the role of nephrectomy, especially in patients with metastatic disease?
Which is the best second- and third-line treatment?
All treatments have to be fully-researched before they can be adopted as standard treatment for everyone. This is to ensure that they are effective, they offer advantages over current available treatments and they are safe. All new treatments undergo rigorous testing in the laboratory and the clinic (clinical trials) before they are awarded a licence for use in the UK. Until studies are completed and new treatments are found to work better than existing treatments, they cannot be used as standard therapy for renal cancer. For new systemic treatments, this testing process can take anything up to 20 years to complete.