Page 14 - CUA KIDNEY CANCER HANDBOOK 2020

Management of Patients with Locally
Advanced Kidney Cancer who are Medically
or Surgically Inoperable

• There is currently insufficient evidence to support a general recommendation
for neoadjuvant therapy

– Some patients with advanced localized disease deemed medically or
surgically inoperable at diagnosis may have a radiological and/or clinical
response to systemic therapy

Many small studies have demonstrated a potential benefit of systemic
n
neoadjuvant approaches (mostly with VEGF inhibitors)
● • Patients who do not have the potential to be converted to an operable state
should be managed according to the guidance for advanced or metastatic
kidney cancer
● • If there is a question that a patient may be converted to an operable state with
systemic therapy, they should be re-evaluated by a multidisciplinary team
● • For patients (particularly those with hematuria) who are symptomatic, other
options such as angioembolization may be considered

10 Practical Approaches to Managing Advanced Kidney Cancer