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Clinical Review State of the Art Review

Renal cell carcinoma

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g4797
  1. Eric Jonasch, associate professor of medicine1,
  2. Jianjun Gao, assistant professor of medicine 1,
  3. W Kimryn Rathmell, associate professor of medicine2
  1. 1Department of GU Medical Oncology, MD Anderson Cancer Center, Houston, TX 77230-1439, USA
  2. 2Comprehensive Cancer Center, Chapel Hill, NC, USA
  1. Correspondence to: E Jonasch ejonasch{at}


The treatment of renal cell carcinoma (RCC) has changed greatly over the past 15 years. Progress in the surgical management of the primary tumor and increased understanding of the molecular biology and genomics of the disease have led to the development of new therapeutic agents. The management of the primary tumor has changed owing to the realization that clean margins around the primary lesion are sufficient to prevent local recurrence, as well as the development of more sophisticated tools and techniques that increase the safety of partial nephrectomy. The management of advanced disease has altered even more dramatically as a result of new agents that target the tumor vasculature or that attenuate the activation of intracellular oncogenic pathways. This review summarizes data from prospective randomized phase III studies on the surgical management and systemic treatment of RCC, and provides an up to date summary of the histology, genomics, staging, and prognosis of RCC. It describes the management of the primary tumor and offers an overview of systemic agents that form the mainstay of treatment for advanced disease. The review concludes with an introduction to the exciting new class of immunomodulatory agents that are currently in clinical trials and may form the basis of a new therapeutic approach for patients with advanced RCC.


  • Contributors: All three authors helped with data gathering, analysis, and synthesis as well as the writing, review and final approval of the manuscript. EJ is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests. EJ: consultant for Aveo, Bayer, GSK, Novartis, and Pfizer; clinical research support from BMS, GSK, Novartis, Pfizer, and Onyx; laboratory research support from Exelixis. WKR: consultant for Aveo (uncompensated), clinical research support from GSK and Seattle Genetics. ); WKR’s husband was funded for a research sabbatical by Novartis pharmaceuticals. JJG: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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