Dr. Shuch on Considerations for Appropriate Treatment in Advanced RCC

Brian M. Shuch, MD, director, Kidney Cancer Program, Alvin & Carrie Meinhardt Endowed Chair of Kidney Cancer Research, University of California, Los Angeles Institute of Urologic Oncology, discusses patient factors to take into consideration when deciding appropriate treatment for patients with advanced renal cell carcinoma (RCC).

This decision-making process needs to be done in a true multidisciplinary setting, Shuch says. If a patient with advanced RCC comes into the clinic with a large primary tumor, low disease burden, and is asymptomatic, they may be a candidate for active surveillance. This is an accepted modality for patients with low-volume disease, Shuch says. Though, surgery is still the preferred approach for eligible patients.

Patients in need of immediate treatment should receive systemic therapy. Moreover, local radiation, palliation, ablation, or metastasectomy can be used to treat distant disease, Shuch notes.

Furthermore, if a patient with significant symptoms does need systemic therapy, risk-stratification can be used to determine whether they should undergo surgery or proceed straight to systemic therapy. Shuch concludes that surgery is still relevant in the new treatment era, but this needs to be discussed with a multidisciplinary team.