which patients do you prescribe targeted therapy for renal cancer without metastases?
The first line treatment of clear cell renal carcinoma is surgery. Targeted treatments should be reserved to the metastatic situation. If there are one or two metastasis that can be taken care by surgery, then surgery of the metastasis plus targeted treatment gives the best results.
If metastasis are beyond surgical possibilities, targeted treatments are the only option. If metastasis are in bones radiotherapy should be used.
The first line targeted treatment should be cabozantinib plus nivolumab. This scheme is superior to sunitinib.
Please check these guidelines
https://pathways.nice.org.uk/pathways/renal-cancer
It also highlights Interim treatment regimens during the COVID-19 pandemic
Tomas Koltai .
thanks for the comment
And do not prescribe in the absence of metastases, but with an aggressive tumor. Moreover, there is a possibility of micrometastases that we cannot detect?
Dear Alexander
Clear cell renal carcinoma is always very aggressive. However I do not think targeted therapy should be used without evidence of metastases.
There is no proof that targeted treatments will prevent metastases after surgery. That is why I prefer to preserve targeted treatments to the metastatic situation.
A very correct approach. Research on this topic is already underway, but not yet completed. it is not yet known how to correctly and optimally apply targeted therapy without metastases. Do you have specific schemes?