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Advanced Renal Cell Carcinoma: Role of the Radiologist in the Era of Precision Medicine.

Abstract For the past decade, advanced renal cell carcinoma (RCC) has been at the forefront of oncologic innovation. Our rapidly evolving understanding of the molecular and genetic basis of RCC has revolutionized the management of advanced RCC; 10 novel molecular targeted agents and immune checkpoint inhibitor have received U.S. Food and Drug Administration approval for treatment of advanced RCC in a little over a decade. Amid this progress, imaging has assumed a central role in metastatic surveillance and follow-up of advanced RCC. State-of-the-art knowledge of the molecular basis of RCC and its treatment and imaging will help ensure that the radiology community remains relevant and central in the care of patients with advanced RCC. This article will review developments in management of advanced RCC from a radiologist's perspective to highlight our clinical role. It will describe how the underlying molecular mechanisms of RCC provide specific targets for novel anticancer agents. The relationship between the mechanisms of action of these novel anticancer agents and the imaging appearance of tumor response will be discussed, along with the available tumor response criteria and their strengths and weaknesses, thus assisting radiologists in response assessment in the setting of clinical trials or routine practice. The class- and drug-specific toxicities and complications associated with the novel anticancer agents will be summarized, since these are frequently missed or misinterpreted and require the radiologist's input in prompt detection and management. The potential role of radiogenomics and texture analysis in the management of advanced RCC will also be discussed. (©) RSNA, 2017.
PMID
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Authors

Mayor MeshTerms

Physician's Role

Precision Medicine

Radiologists

Keywords
Journal Title radiology
Publication Year Start




PMID- 28723287
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170731
LR  - 20170731
IS  - 1527-1315 (Electronic)
IS  - 0033-8419 (Linking)
VI  - 284
IP  - 2
DP  - 2017 Aug
TI  - Advanced Renal Cell Carcinoma: Role of the Radiologist in the Era of Precision
      Medicine.
PG  - 333-351
LID - 10.1148/radiol.2017160343 [doi]
AB  - For the past decade, advanced renal cell carcinoma (RCC) has been at the
      forefront of oncologic innovation. Our rapidly evolving understanding of the
      molecular and genetic basis of RCC has revolutionized the management of advanced 
      RCC; 10 novel molecular targeted agents and immune checkpoint inhibitor have
      received U.S. Food and Drug Administration approval for treatment of advanced RCC
      in a little over a decade. Amid this progress, imaging has assumed a central role
      in metastatic surveillance and follow-up of advanced RCC. State-of-the-art
      knowledge of the molecular basis of RCC and its treatment and imaging will help
      ensure that the radiology community remains relevant and central in the care of
      patients with advanced RCC. This article will review developments in management
      of advanced RCC from a radiologist's perspective to highlight our clinical role. 
      It will describe how the underlying molecular mechanisms of RCC provide specific 
      targets for novel anticancer agents. The relationship between the mechanisms of
      action of these novel anticancer agents and the imaging appearance of tumor
      response will be discussed, along with the available tumor response criteria and 
      their strengths and weaknesses, thus assisting radiologists in response
      assessment in the setting of clinical trials or routine practice. The class- and 
      drug-specific toxicities and complications associated with the novel anticancer
      agents will be summarized, since these are frequently missed or misinterpreted
      and require the radiologist's input in prompt detection and management. The
      potential role of radiogenomics and texture analysis in the management of
      advanced RCC will also be discussed. (c) RSNA, 2017.
FAU - Shinagare, Atul B
AU  - Shinagare AB
AD  - From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, 
      Boston, MA 02215; and Department of Radiology, Brigham and Women's Hospital,
      Boston, Mass.
FAU - Krajewski, Katherine M
AU  - Krajewski KM
AD  - From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, 
      Boston, MA 02215; and Department of Radiology, Brigham and Women's Hospital,
      Boston, Mass.
FAU - Braschi-Amirfarzan, Marta
AU  - Braschi-Amirfarzan M
AD  - From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, 
      Boston, MA 02215; and Department of Radiology, Brigham and Women's Hospital,
      Boston, Mass.
FAU - Ramaiya, Nikhil H
AU  - Ramaiya NH
AD  - From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, 
      Boston, MA 02215; and Department of Radiology, Brigham and Women's Hospital,
      Boston, Mass.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Radiology
JT  - Radiology
JID - 0401260
SB  - AIM
SB  - IM
MH  - Carcinoma, Renal Cell/*diagnostic imaging/*drug therapy/genetics
MH  - Humans
MH  - Kidney Neoplasms/*diagnostic imaging/*drug therapy/genetics
MH  - *Physician's Role
MH  - *Precision Medicine
MH  - *Radiologists
EDAT- 2017/07/21 06:00
MHDA- 2017/08/02 06:00
CRDT- 2017/07/21 06:00
AID - 10.1148/radiol.2017160343 [doi]
PST - ppublish
SO  - Radiology. 2017 Aug;284(2):333-351. doi: 10.1148/radiol.2017160343.