Is there a role for presurgical therapy for renal cell carcinoma?

Overview

The recent emergence of effective molecular targeted therapies, such as antibodies neutralizing VEGF, inhibitors of tyrosine kinase and mTOR inhibitors, has sparked an interest in their use prior to surgical resection of renal cell carcinoma (RCC), a practice commonly used in the treatment of many other advanced solid tumors. The antitumor activity and relatively favorable toxicity profile of these novel agents have resulted in many patients with locally advanced or metastatic RCC receiving targeted therapies. In view of the lessons learned from the immunotherapy era, the following review examines the role of surgery in patients with locally advanced and metastatic RCC and the potential benefits and pitfalls of presurgical therapy with targeted molecular agents administered before surgery or in the presence of metastatic disease.