Recent advances in the understanding of the molecular and genetic factors in renal cancer allow you to change the prognosis and treatment of this tumor.

-the incidence of this type of tumor is increasing between a 7.5 and 10% annually, mainly for diagnostic advances and the longevity of the population

-thanks to genomic and molecular studies, experts rely on that in the near future will be able to select patients for each treatment and improve the administration of the same sequence, making greater and better survival of patients with metastatic kidney cancer

-new drugs, including pazopanib, are changed radically the prognosis of patients with renal cell cancer

Málaga, 2011-October 2650 cases of kidney cancer are diagnosed in Spain each year (more than 1,400 men and the) (rest in women), disease whose incidence worldwide lies between 2.4 and 6 cases per 100,000 inhabitants.

The incidence of this type of tumor is increasing in recent years among a 7.5 and 10% annually, mainly for diagnostic advances and the longevity of the population ”, points out Dr. José Luis González Larriba, Chief of section of medical oncology at the Hospital Clínico San Carlos of Madrid and Professor of the Complutense University of Madrid.

In the last decade, knowledge of the molecular, genetic factors and angiogénicos in the genesis of renal cancer has allowed to change their prognosis and therapeutic attitude.

In order to analyse these advances, within the framework of the Congress of the Sociedad Española de Oncología Médica (SEOM), which takes place in Malaga, is held the Symposium ‘ moving from standards to new concepts in the approach to the renal cell cancer metastatic (CCRm) ’, with the collaboration of GlaxoSmithKline (GSK).

Every day know better the mechanisms involved and their different steps on the proliferation and spread of this neoplasm process ”, points out Dr. González Larriba. This has allowed to develop various actors, mainly directed against these mechanisms, such as tirosin-the recipient cell angiogénicos kinase inhibitors and mTOR inhibitors.

Also – adds this expert-recently have drugs that optimize the relation benefit/toxicity as pazopanib, that achieves a high efficiency, with clinical benefit in more than 75% of patients, prolonging the time until the progression of the disease and the survival of patients, while it presents a low toxicity and excellent tolerance of the same ”.

In this regard, various clinical trials which analysed pazopanib compared to placebo, have demonstrated that this new treatment has an important efficiency and with the same quality of life than patients receiving placebo, what is a synonym for scarce and small relevance of side effects ”, says Dr. González Larriba.

Dr. Joaquim Bellmunt, oncologist of the Hospital del Mar of Barcelona, moderator of the Symposium is expressed in the same line and also rapporteur talk ‘ how we can integrate new therapies in daily clinical practice? ’

says this expert, have recently published the results of the use of pazopanib in first and second linewhich show a level of efficiency, in terms of survival free of disease, similar to other treatments of first line – in patients of good prognosis and outcome through-with an adequate profile of tolerability for the patient ”.

Additional studies with pazopanib as the Comparz (which evaluates the efficacy, tolerability and progression-free survival) or the PISCES (that will analyze the degree of acceptance by the patient of pazopanib as a therapeutic option in first-line) are currently underway. As emphasized Dr. Bellmunt it is important to know what level of tolerability of each treatment, because it’s patients which is prolonged in these cases and progression-free survival, the tolerance shown to these treatments is essential ”.

Pazopanib has recently been approved by the Spanish health regulatory authorities as a new therapeutic option for patients with advanced renal cell cancer. This new oral treatment has demonstrated its effectiveness in reducing the size of the tumor and delay the progression of the disease, without clinically important differences in the quality of life with respect to placebo. Their efficacy and good tolerability profile placed pazopanib as an important step for these patients

study of molecular or genomic determinants

all trials underway with new therapeutic agents currently associate study of molecular or genomic determinants that allow to optimize these therapies, as well as be able to predict that patients should continue or not with a drug given.

In this regard, Dr. Bellmunt asserts that according to recent data, the intrinsic genomic profile of our germ-line gene can predict the response to these drugs. Various mutations in regulatory genes in angiogenesis studies demonstrate that the presence or not of certain mutations in a small nucleotide predict the likelihood that a patient may respond to or not an anti-angiogenic treatment. Don’t talk about features of the tumor, but intrinsic mutations in the DNA of the patient which determine response or toxicity ”.
We hope that in future studies of biomarkers, proteins involved in the onset and progression of the tumor, or certain genetic polymorphisms, help us also select these patients, as well as the best sequence of administration of the various actors, allowing a greater and better survival of patients with metastatic kidney cancer ”, concludes Dr. González Larriba.

Diagnosis and symptoms in renal cancer

Approximately one third of cases of kidney cancer have metastatic disease in the initial diagnosis, 25% locoregional disease and between 40% and 45% Stadium located, and therefore, resectable at the beginning. The third part of localized unresectable locally advanced tumors will lie along the evolution, and around 60% of all kidney cancers are going to have metastatic disease at some point in its evolution.

Classic initial symptoms in renal cancer presence of back pain, palpable abdominal mass and hematuria, however, are often only appears hematuria or inconvenience lumbar, noting in imaging the presence of solid renal mass. In this regard, the expert notes that increasingly more frequently are asymptomatic patients where it appears or is diagnostic renal cancer by chance doing testing image to study any other unrelated pathology ”.

Although it may appear at any age, this tumor is most common at 50 – 60 years of age. The man/woman ratio is 1.6, which assumed that the incidence is twice in men than in women.

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