Raghavan Deepa, Gibatova Viktoriya, Vojjala Nikhil, Moka Nagaishwarya, Yen Aihua Edward
School of Medicine, Wayne State University, Detroit, MI 48201, USA.
School of Medicine, Ross University, Miami, FL 33027, USA.
Cancers (Basel). 2025 May 14;17(10):1656. doi: 10.3390/cancers17101656.
The effectiveness of immunotherapy and targeted therapy has been well established in metastatic renal cell cancer (mRCC). These therapies demonstrated higher overall response rates and led to prolonged survival. In contrast, in localized RCC, conventional treatment is either partial or complete nephrectomy. While surgery is a curative option in early stages, high recurrence rates remain a concern, with survival rates ranging from 53% to 85%, depending on the initial stage at the time of diagnosis. Given favorable outcomes with systemic therapies in the metastatic setting, there has also been an increased interest in utilizing these therapies for the localized stage with the rationale to eradicate the micro-metastatic clone, thereby reducing the recurrence rates. Despite these encouraging developments, challenges regarding the optimal timing, duration, and combination of systemic therapies are still under investigation. Adding to that, balancing the benefits of systemic therapies with potential toxicities is also crucial, especially in patients who might otherwise benefit from surgery alone. This review describes the current landscape, ongoing clinical trials, and future directions of systemic therapy in the management of localized RCC.
免疫疗法和靶向疗法在转移性肾细胞癌（mRCC）中的有效性已得到充分证实。这些疗法显示出更高的总体缓解率，并延长了生存期。相比之下，在局限性肾细胞癌中，传统治疗方法是部分或全肾切除术。虽然手术是早期阶段的一种治愈性选择，但高复发率仍然令人担忧，生存率在53%至85%之间，具体取决于诊断时的初始阶段。鉴于全身治疗在转移性疾病中的良好疗效，人们也越来越有兴趣将这些疗法用于局限性阶段，其理论依据是根除微转移克隆，从而降低复发率。尽管有这些令人鼓舞的进展，但关于全身治疗的最佳时机、持续时间和联合应用的挑战仍在研究中。此外，平衡全身治疗的益处与潜在毒性也至关重要，特别是对于那些原本可能仅从手术中获益的患者。本综述描述了局限性肾细胞癌治疗中全身治疗的现状、正在进行的临床试验以及未来方向。
