Adjuvante postoperative therapie beim nierenzellkarzinom

Nephrectomy provides curative treatment of local renal cell carcinoma. Unfortunately 30% of patients experience recurrence and metastases with 7 year overall survival rates below 10%. In these patients adjuvant therapy would be indicated. The risk stratification is imperative for proper patient selection in adjuvant settings. Ideally high-risk patients can be identified and efficient therapy can be offered to those who would benefit most from adjuvant therapy. Hormonal and immunotherapy has been administered in this setting with high toxicity and no improvement in progression-free survival. In contrast adjuvant therapy with autologous tumor cell vaccine (Reniale®) demonstrated an improvement of progressionfree survival and overall survival with moderate side effects. Targeted small molecule inhibitors such as sunitinib, sorafenib, temsirolimus and everolimus have demonstrated great potential for advanced or disseminated renal cell carcinoma. The adjuvant use of these agents seems to be promising. Sorafenib and sunitinib are currently under clinical investigation in several phase III trials. Another phase III trial investigating the adjuvant use of the monoclonal antibody G250 for clear cell renal carcinoma is being carried out. First results of the studies are expected to be available in 2012.