[Renal carcinoma and fatigue: which challenge in the era of antiangiogenic drugs?].

The perspectives of renal cell carcinoma (RCC) treatment have improved with the development of targeted molecular therapies against VEGFR/VEGF-mediated angiogenesis and mTOR. Antiangiogenic drugs, including bevacizumab (in association with IFN-α), sorafenib, sunitinib and pazopanib have demonstrated benefits for patients in terms of life expectancy, with progression free survival and overall survival exceeding 10 and 24 months, respectively. Long-term administration of these drugs, over several months or several years, requires the compliance of patients. Phase II/III studies on antiangiogenic-based therapy in RCC showed a high prevalence of fatigue (20 to 56%), whatever the drug assessed, but with the lowest rates observed with sorafenib or pazopanib. Fatigue is considered by cancer patients as the most important secondary effect regarding the impact on their quality of life and, consequently, is expected to compromise the protocol and the efficacy of the treatment. Management of fatigue induced by therapy or the disease is based on patient information, identification and treatment of causal aetiologies, anti-inflammatory therapy when needed and education and psychological support. Anticipating the risk and level of fatigue expected to be associated with cancer therapy by using both reliable and simple tools remains a challenge in oncology practice. The expected overall benefits of these targeted therapies, coupled with daily assessment and management of fatigue induced by the disease or the treatment, will offer new perspectives for patients with RCC. In this purpose, studies in oncology on the reliability of simple tools based on patient reporting and adapted to clinical practice, as well as interventional studies on fatigue management are needed.