EAU launches new clinical guidelines for 2009 -- kidney cancer

A number of updated guidelines will be presented at the 24th Annual Congress of the European Association of Urology (EAU) held in Stockholm, from 17 though 21 March. The abridged versions - Pocket Guidelines – which are based on the extended text documents will also be available in Stockholm to all EAU members and press. Production of clinical guidelines is one of the core activities of the organisation. Close to 150 experts split up over 18 different topic-oriented panels, are involved in this ongoing process. Guidelines aim to present the best evidence available on a given pathology and provide a standardized approach to the treatment of urological conditions. Ultimately, healthcare professionals must make their own decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise.

Kidney Cancer

Due to the enhanced use of imaging techniques over the past years a stage shift has been seen in the field of renal cell cancer with a volume increase in the incidental detection of smaller cancers (< 4 cm). Thirty percent of these findings are benign. The treatment of metastatic small tumours show a decrease in death rates. A considerable portion of these tumours can be treated with nephron sparing surgery. Additionally, a number of targeted agents have become available with several more expected shortly.

The panel updated these Kidney Cancer guidelines since for several targeted agents more mature data have been published and validated prognostic nomograms predicting treatment outcome accuracy are available for more treatment options.

The panel do not recommend Interferon-alpha (IFN-alpha) in a first-line setting as monotherapy in the treatment of metastatic RCC. Sunitinib and Bevacizumab + IFN-alpha are recommended as first-line therapy in low- and intermediate-risk patients while

Temsirolimus is recommended for high risk patients; Sorafenib and Everolimus can be recommended as second-line therapy after cytokine and tyrosine kinase inhibitor (TKI) failure, respectively.

The expectation is that further targeted agents will be on the market shortly. Also the role of molecular medicine in the treatment of renal cell carcinoma will become more prominent. A subsequent update will take this information in, once sufficiently data is available.

The panel consists of an expert group chaired by B. Ljungberg and includes D.C. Hanbury, M.A. Kuczyk, A.S. Merseburger, P.F.A. Mulders, J-J. Patard and I.C. Sinescu.

Source: European Association of Urology