Abstract and Introduction
Abstract
Treatment options for renal cell carcinoma have changed dramatically since 2005 when the U. S. Food and Drug Administration approved six new therapies. These agents inhibit pathways relevant in the pathogenesis of renal cell carcinoma, interfering with tumor angiogenesis, cell progression, and metastasis. Understanding the pharmacology of these agents is necessary for clinicians to provide appropriate patient education, assure adherence with the treatment plan, and facilitate early identification and intervention for side effects. These activities will provide positive clinical outcomes.
Objectives
1. Describe the etiology and pathophysiology of renal cell carcinoma.
2. Explain two pharmacologic management systems for treatment of renal cell carcinoma.
3. Outline nursing interventions for renal cell carcinoman.
Introduction
Renal cell carcinoma is the third most common genitourinary cancer in the United States. It is estimated that in 2009, 57,760 Americans were diagnosed with cancer of the kidney or renal pelvis, with 12,980 dying from this disease (National Cancer Institute, 2009). The incidence of renal cancer increases steadily between the ages of 25 and 79 years, with peak incidences occurring between ages 40 and 70 years. According to Jamal and associates (2009), there is an estimated 5-year survival rate of 67%. The differences in histological subtypes of renal cell carcinoma are related to molecular events leading to oncogenesis and reflect the dissimilar clinical course of renal cancer (Uzzo et al., 2003).
Scientific understanding of the molecular basis of cancer and the role of growth factors have resulted in the identification of signaling pathways relevant in the pathogenesis of renal cell carcinoma. This knowledge provided the impetus for developing new drugs that target and inhibit these diff e rent pathways. Previously, systemic therapy for renal cancer has been limited to the use of interleukin-2 and the off-label use of interferon. These d rugs formulated an immunotherapeutic approach to the treatment of advanced renal cancer. Translational research and participation of patients with advanced renal cell carcinoma in clinical trials have resulted in the approval of six systemic targeted therapies. These include sorafenib tosylate (Nexavar®), sunitinib malate (Sutent®), temsirolimus (Torisol®), everolimus (Afinitor®), bevacizumab (Avastin®) in combination with interferon, and most recently, pazopanib (Votrient™). Each of these drugs has increased therapeutic options and appears to prolong survival for patients with advanced renal cancer.
Nursing care for patients undergoing treatment with these medications should include education, identification, and management of side effects. This information will have significant impact on the quality of life and treatment outcomes for these patients. Understanding the mechanism of action, signaling pathways involved in each therapy, potential adverse effects, drug interactions, and other precautions will allow nurses to provide comprehensive care for patients with renal cell carcinoma.