**Author details**

Archil Chkhotua\* , Laurent Managadze and Ambrosi Pertia

\*Address all correspondence to: achkhotua@gmail.com

National Centre of Urology, Tbilisi, Georgia

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**Chapter 9**

**Current Perspectives in Metastatic Renal Cell Carcinoma**

Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and close to 90% of all renal neoplasms. Renal cell carcinomas, by definition, are tumors that originate in the renal cortex. These tumors are often asymptomatic, have diverse clinical manifestations, and can be associated with hereditary syndromes. Surgery is the treatment of choice for localized RCC. In localized RCC, partial nephrectomy for small tumors and radical nephrec‐ tomy for larger tumors continue to be the gold standard. Surgical practice has reduced morbidity and has advanced toward more limited and less invasive resection approaches. In addition, cytoreductive nephrectomy is often indicated before embarking on systemic

In recent years, there has been a shift from radical nephrectomy toward more nephron-sparing approaches. RCC still remains a predominantly surgical disease because RCCs are frequently characterized as tumors that are resistant to chemotherapy and radiation. However, advances in the treatment of metastatic RCC have evolved, primarily with biologic response modifiers.

The management of RCC has undergone the most significant transformation. Scientific understanding of the molecular basis of cancer and the role of growth factors have resulted in the identification of signaling pathways relevant in the pathogenesis of renal cell carcinoma. This knowledge provided the impetus for developing new drugs that target and inhibit these diff e rent pathways. Previously, systemic therapy for renal cancer has been limited to the use of interleukin-2 and the off-label use of interferon. These drugs formulated an immunothera‐ peutic approach to the treatment of advanced renal cancer. Translational research and participation of patients with advanced renal cell carcinoma in clinical trials have resulted in

> © 2013 Michalaki et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Michalaki et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Treatment: The Role of Targeted Therapies**

V. Michalaki, M. Balafouta, D. Voros and

treatment in patients with metastatic disease.

Additional information is available at the end of the chapter

C. Gennatas

**1. Introduction**

http://dx.doi.org/10.5772/54856
