Renal Cancer Subtypes: Should We Be Lumping or Splitting for Therapeutic Decision Making?

摘要

The treatment of advanced renal cell carcinoma has posed a challenge for decades, in part because of common themes related to intrinsic resistance to cytotoxic chemotherapy, and the obscure biology of these cancer types. Forward movement in the treatment of the renal cell carcinomas can thus be approached in two ways: splitting the tumor types along histologic and molecular features, in the hopes of coupling highly precision-focused therapy on a subset of disease with most potential for benefit, or lumping the various biologies and histologies together, in order to carry the rarer renal cell carcinoma types with more common disease. The former strategy satisfies our desire for customized precision in treatment delivery, while the latter strategy allows us to offer a wider therapeutic menu in a set of diseases we are continuing to learn about on a physiologic and molecular level.