%0 Journal Article
%T Delivering preventive, predictive and personalised cancer medicine for renal cell carcinoma: the challenge of tumour heterogeneity
%A Rosalie Fisher
%A James Larkin
%A Charles Swanton
%J EPMA Journal
%D 2011
%I BioMed Central
%R 10.1007/s13167-011-0137-3
%X Renal cell carcinoma is a relatively rare cancer in which prognosis is highly individualRenal cell carcinoma (RCC) is an epithelial neoplasm arising from the parenchyma of the kidney, which accounts for 95% of renal neoplasms, and 3% of adult malignancies [1]. RCC is a relatively rare cancer, with an incidence of 60,000 cases in the European Union in 2006, but is associated with a high mortality rate; in the same year, there were 26,000 deaths due to this disease [2].The prognosis in RCC has traditionally been thought to be influenced by tumour stage, nuclear grade and histologic tumour necrosis [3]. Those patients with disease confined to the kidney and regional lymph nodes are treated with nephrectomy (partial or radical) with curative intent. However, approximately one third of patients have metastases at the time of diagnosis [4], and a similar proportion develop metastatic disease within 5 years of follow up [5]. Common secondary sites include lymph nodes, lung and bone.Metastatic RCC (mRCC) is incurable, and the aim of therapy for patients with advanced disease is to control the disease burden for as long as possible, thus ameliorating the patient's symptoms and improving quality of life, and prolonging overall survival time. Nephrectomy is still considered standard treatment for those patients who have a good performance status and a limited burden of metastatic disease, based on the results of two randomised studies which found a survival benefit for patients treated with nephrectomy and cytokine therapy, compared with cytokine therapy alone [6]. Historically, patients with mRCC have had extremely limited systemic treatment options and poor 5 year survival rates. Hormone therapy and chemotherapy produce response rates of 10% or less [7,8]. Cytokine therapy, including interferon alfa and high dose interleukin-2, may benefit a small proportion of patients, resulting in response rates of 10-20%, and a modest survival benefit of several months over non-immunothe
%K Renal cell carcinoma
%K Heterogeneity
%K Personalised medicine
%K Predictive biomarkers
%U http://www.epmajournal.com/content/3/1/1