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Renal Cell Carcinoma and Metastatic Bone Disease

Janet E Brown, MD, MRCP

Renal cell carcinoma (RCC) accounts for approximately 80% of all renal malignancies and 3% of all cancers, and an increasing number of RCCs are being diagnosed [1–3]. RCC includes clear-cell, papillary, and chromophobe subtypes, with clear-cell disease being the most common by far. Between 20% and 50% of newly diagnosed patients already have distant metastases (one-third is generally accepted as a working estimate) [3]. In another one-third of patients, metastatic disease appears later, following nephrectomy and during disease progression; thus, overall, the majority of patients diagnosed with RCC will develop distant metastases. Until the current decade, drug therapy for RCC patients with metastases was limited to interferon-α and interleukin-2, with poor response rates and survival times of approximately 12 months after the diagnosis of metastasis [1,3]. Recently, however, there have been major advances in the treatment of metastatic RCC through targeted therapy using tyrosine kinase inhibitors (e.g. sunitinib and sorafenib) and mammalian target of rapamycin (mTOR) inhibitors (e.g. everolimus and temsirolimus). These therapies have dramatically improved response rates and, in the case of sunitinib, have shown indications of improving survival [4]. For the first time for many years, we can now look forward with some optimism to the likelihood of significantly improved survival and quality of life in patients with advanced RCC.

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