Abstract

Renal cell cancer incidence is fastly growing worldwide. In spite of major advances in the treatment of metastatic disease, to date there is no adjuvant therapy proven feasible in high risk patients after radical resection. An effective adjuvant agent against renal cell cancer should be relatively non toxic, have estabilished efficacy in the metastatic setting and have demonstrated effectiveness against the standard of care in randomized Phase III trials. The development of adjuvant therapy requires the proper identification of patients at highest risk of relapse; our ability to predict the recurrence has much room for improvement. To date, only an autologous vaccine has achieved a significant benefit in the adjuvant setting for renal cell carcinoma. The recent arrival of new drug classes, such as tyrosine kinase inhibitors and monoclonal antibodies, strongly improving overall and progression free survivals in the metastatic disease, has renewed the hopes on the adjuvant treatment of the disease. Several studies have been performed in the past using radiation treatment and systemic agents, including chemotherapy, immunotherapy and hormonal treatments, with adjuvant purpose; new trials are in progress to evaluate the effectiveness of antiangiogenic agents in this setting. An overall review of the completed and upcoming trials and patents on this issue shall be discussed in this chapter.