Safety and efficacy of preoperative sorafenib therapy in facilitating cytoreductive surgery in renal cell carcinoma

With 65,000 new cases in the USA in 2013, the incidence of kidney cancer has doubled in last decade and accounted for 13,600 deaths in 2013 [1,2]. Renal cell carcinoma (RCC), which consists of 80% of kidney cancers in adults [3], presents with advanced or metastatic stage in approximately a third of patients. A third of early-stage RCC will subsequently recur or progress to metastatic disease after initial nephrectomy [4]. Historically, once surgical options were exhausted, metastatic RCC was regarded as refractory to any systemic therapy. The identification of the role of VEGF and mTOR in the development and progression of RCC has led to the discovery of several targeted therapies. Many of these agents, including tyrosine kinase inhibitors (sorafenib, sunitinib, pazopanib and axitinib), VEGF inhibitor (bevacizumab used in combination with IFN-α) and mTOR inhibitors (temsirolimus and everolimus) have now received US FDA approval. Despite all these advancements, metastatic RCC still remains an incurable disease with a median overall survival rate in the range of approximately 2 years [4]. In this article, we discuss the role of cytoreductive surgery in the era of targeted agents, and the role of preoperative use of sorafenib.

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