Imaging of Metastatic Clear Cell Renal Cell Carcinoma: Objectifying Imaging Changes Post-TKI

摘要

The National Cancer Institute estimates that 64,770 new cases and 13,570 deaths from kidney cancer in the United States occurred in 2012. Though a greater number of incidentally detected renal tumors are at a stage where surgery is curative, renal cell carcinoma (RCC) remains a clinically occult tumor, with up to one-third of patients presenting with advanced stage, harboring a 5-year survival rate of about 20%. The elucidation of the cytogenetic mechanism of hypoxia-inducible factor alpha cascade and VHL suppressor gene in the development of clear cell RCC has led to the discovery of various vascular endothelial growth factor-targeted therapy agents (also known as tyrosine kinase inhibitors [TKIs]) in treatment of metastatic clear cell renal cell carcinoma (mRCC). As with patients with other vascular tumors treated with targeted therapy, such as metastatic gastrointestinal stromal tumor with imitanib, TKI-treated patients treated with mRCC have an improved response and survival when compared to those treated with conventional chemotherapy (CT). Sunitinib and sorafenib are two such biologic agents that have been approved as first-line therapy for clear cell mRCC. These antiangiogenic TKIs exhibit both cyto-toxic and cytostatic properties and cause tumor regression and tumor growth suppression.