Abstract
Renal cell carcinoma is the most common primary tumor of the kidney. For as yet unexplained reasons, the incidence of renal cell carcinoma in the Czech Republic is the highest in the world.
Surgery is the mainstay of treatment of localised and locally advanced renal cell carcinoma, and remains the only curative option. The treatment of advanced and metastatic renal cell cancer is based on systemic therapy in combination with cytoreductive local approaches.
Cytokines, used in the past, may currently be beneficial for patients in the good prognostic group, but molecularly targeted biological treatment, mainly directed at key points of the defective VHL/HIF pathway, have shown significantly better efficacy in patients of all prognostic groups with prolonged survival compared to interferon-alpha. Currently, inhibitors of tyrosine kinase receptor for angiogenic growth factors including sorafenib, sunitinib, pazopanib, and axitinib, the monoclonal antibody neutralizing vascular endothelial growth factor bevacizumab, and mTOR kinase inhibitors temsirolimus and everolimus are registered for the first or second-line treatment of advanced and/or metastatic disease.
Immunotherapeutic agents including nivolumab, and adjuvant therapies using multikinase inhibitors and the monoclonal antibody against carboanhydrase IX are expected to enhance the therapeutic armamentarium in the near future.