Adjuvant therapy for renal cell carcinoma: Targeted approaches

Renal cell carcinoma (RCC) remains a significant global health problem. Despite inroads in early detection, ∼50 %of patients either present with or develop metastatic disease during the natural history of their illness. There remains no consistent curative therapy for metastatic RCC. For patients with locally advanced disease, surgery remains the mainstay of curative therapy, but a significant number of patients still experience relapse, the risk of which is directly related to the presence of high-risk features at diagnosis. The search for effective adjuvant therapy to decrease the risk of relapse following surgery remains elusive. Therapeutic benefit in the setting of metastatic disease has not translated to success in the adjuvant therapy setting. Numerous clinical trials have examined the role of radiation therapy, immunotherapy, chemotherapy, vaccine therapy, and antiangiogenic therapies in the adjuvant setting. To date, none of these trials have demonstrated a significant benefit. Thus, the standard of care remains surveillance following surgical resection of locally advanced disease. Currently, clinical trials with the new targeted therapies developed for RCC are ongoing in the adjuvant setting. We anxiously await the results of these trials to determine whether they can significantly impact recurrence free and overall survival in the locally advanced setting following curative surgical resection.