Renal Cell Carcinoma: Molecular Biology, Immunology, and Clinical Management (Current Clinical Oncology) - Hardcover

Hardcover

ISBN 10: 0896037819 ISBN 13: 9780896037816

Publisher: Humana Press, 2000

Synopsis

Renal cell carcinoma represents a heterogeneous group of tumors, the most common of which is clear cell adenocarcinoma. The annual incidence of this tumor appears to be rising and approximately 12,000 individuals die from this cancer annually in the United States. One third of patients who present have metastatic disease at the time of diagnosis, and another 40% who undergo nephrectomy will ultimately develop this complication. Over the past 10 years, a significant amount of new information concerning the epidemiology, mole- lar and immunologic characteristics, and therapy for patients with these tumors has appeared. The recognition that inherited forms of renal cancer exist, and that chromosomal abn- malities can be identified in these tumors, suggested a genetic basis for renal cell carcinoma. The familial cancer syndrome, Von Hippel Lindau disease, provided the setting in which the genetic abnormalites associated with the development of renal cancer were first described. Abnormalities of the VHL gene have also been detected in sporadic clear cell carcinoma, and it has now been recognized that approximately 80 % of these tumors will demonstrate ch- acteristic alterations. Currently the functions of the VHL protein are being investigated, and the biology of clear cell carcinoma of the kidney is under study. Additionally, papillary carcinomas of the kidney appear to express different molecular defects, and these are now being unraveled.

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Reviews

Renal-cell carcinoma is sometimes said to be the cancer that is most resistant to both chemotherapy and radiation therapy. Once renal-cell carcinoma has spread beyond the kidney, therapeutic options are limited. In the United States alone, 12,000 people die each year of metastatic renal cancer. As the authors of the chapter on chemotherapy in this book emphasize, "Clearly, new targets and drugs need to be identified, if response and survival are to be improved."

Two features of renal-cell carcinoma suggest that the future of treatment for renal cancer lies in immunologic or targeted therapeutic strategies. First, renal-cell carcinoma occasionally responds dramatically to immunotherapy. Second, the von Hippel-Lindau gene is mutated or inactivated in at least 80 percent of sporadic renal-cell carcinomas. This high rate of mutation of a single gene provides a target for the development of specific therapies: the cellular pathways controlled by the von Hippel-Lindau protein.

Renal Cell Carcinoma: Molecular Biology, Immunology, and Clinical Management is a concise, well-organized book that discusses nearly every aspect of renal cancer, from epidemiology and pathology to the management of specific clinical situations and recent research in immunotherapy. Some topics, such as epidemiology and paraneoplastic syndromes, are dealt with only briefly. Others are explored in considerable depth, including the immunologic abnormalities associated with renal-cell carcinoma, progress in biologically based therapies, and surgical management. With only occasional exceptions, the amount of space devoted to a topic is clearly correlated with its likely importance in the future of therapy for renal-cell carcinoma.

The book has three parts. The first, an introductory part, includes chapters on epidemiology, pathology, and molecular genetics. The second and shortest part, entitled "Management of Localized Renal Cell Carcinoma," focuses primarily on surgical management. The third, entitled "Management of Advanced and/or Metastatic Renal Cell Carcinoma," includes chapters on clinical management, chemotherapy, immunotherapy, and antiangiogenesis. The chapter on chemotherapy is appropriately brief, since cytotoxic agents generally do not result in meaningful response rates. However, this chapter includes an extremely useful, eight-page table summarizing the results of phase 2 trials of chemotherapy and immunotherapy.

This book has many strengths. One is its organization. Each chapter is divided into clearly labeled, short subsections, making it highly readable and allowing the reader to locate information on a particular topic efficiently. A second strength is its emphasis on the immunologic features of renal cancer. Nearly 100 pages deal with disease mechanisms and biologically based therapies, including chapters on immune-system abnormalities, interleukin-2, interferon, monoclonal-antibody therapy, and adoptive immunotherapy. These chapters are particularly well referenced and include references as recent as 1999.

Perhaps the only important weakness of this book is its too-brief discussion of the function of the von Hippel-Lindau protein. The function of this protein is certain to be important in the development of targeted therapy. The chapter on screening for renal-cell carcinoma mentions several putative functions of von Hippel-Lindau protein, and the chapter on angiogenesis refers to the role of this protein in inhibiting the expression of vascular endothelial growth factor. Admittedly, however, the function of von Hippel-Lindau protein is a difficult and rapidly evolving topic, and reviews are readily available in other publications.

This excellent book is both useful and readable. Because of its wide scope but concise organization, it will be valuable to nearly everyone interested in renal cancer, including surgical and medical oncologists, clinical investigators, and laboratory investigators. Its interdisciplinary appeal sets the stage for the development of new therapeutic strategies for renal-cell carcinoma, which will certainly require an interdisciplinary approach.

Elizabeth Petri Henske, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Edition details

• Publisher: Humana Press
• Publication date: 2000
• Language: English
• ISBN 10: 0896037819
• ISBN 13: 9780896037816
• Binding: Hardcover
• Edition number: 1
• Number of pages: 434
• Editor: Bukowski Ronald M., Novick Andrew