Produção Nacional
Revisado por pares
Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update
2024; Springer Science+Business Media; Volume: 150; Issue: 4 Linguagem: Inglês
10.1007/s00432-024-05663-z
ISSN1432-1335
AutoresAndrey Soares, Fernando Sabino Marques Monteiro, Karine Martins da Trindade, Adriano Gonçalves e Silva, Ana Paula Garcia Cardoso, André Deeke Sasse, André P. Fay, André Paternò Castello Dias Carneiro, Antonio Machado Alencar, Augusto César de Andrade Mota, Bruno Santucci, Daniel M. Girardi, Daniel Herchenhorn, Daniel Vilarim Araújo, Denis L. Jardim, Diogo Assed Bastos, Diogo Rodrigues da Rosa, Fabio A.B. Schutz, Fabio Kater, Felipe da Silva Marinho, Fernando Cotait Maluf, Fernando Nunes Galvão de Oliveira, Fernando Vidigal, Igor Alexandre Protzner Morbeck, José Augusto Rinck Júnior, L. Costa, Manuel Caitano Maia, Manuela Zereu, Marcelo Roberto Pereira Freitas, Mariane Sousa Fontes Dias, Milena Shizue Tariki, Pamela Carvalho Muniz, Patrícia Medeiros Milhomem Beato, Paulo Sérgio Moraes Lages, Pedro Isaacsson Velho, Ricardo Saraiva de Carvalho, Rodrigo Mariano, Sandro Roberto de Araújo Cavalléro, Thiago Martins Oliveira, Vinícius Carrera Souza, Òren Smaletz, Stênio de Cássio Zéqui,
Tópico(s)Economic and Financial Impacts of Cancer
ResumoAbstract Purpose Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil. Methods A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence. Results Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease. Conclusion Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.
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