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  • 1. Escudier, Bernard
    et al.
    Osanto, Susanne
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Porta, Camillo
    Wagstaff, John
    Mulders, Peter
    Gore, Martin
    Bex, Axel
    Bellmunt, Joaquim
    Bracarda, Sergio
    Franklin, Alex
    Honoré, Per Hartvig
    Ravaud, Alain
    van Steijn, Jeanne
    Aziz, Zeba
    Akaza, Hideyuki
    Multidisciplinary management of metastatic renal cell carcinoma in the era of targeted therapies2012In: Cancer Treatment Reviews, ISSN 0305-7372, E-ISSN 1532-1967, Vol. 38, no 2, p. 127-132Article, review/survey (Refereed)
    Abstract [en]

    The use of targeted agents to treat metastatic renal cell carcinoma (mRCC) has significantly extended progression-free and overall survival but raises issues relating to the long-term delivery of care and the sustained monitoring of efficacy and toxicities, certain of which have not previously been experienced. In this paper, an expert group of medical oncologists, urologists and oncology nurses and pharmacists review and make informal recommendations on the multidisciplinary management of mRCC in the light of progress made and problems that have arisen. Decentralisation of care, with a shift in emphasis from large to small hospitals and possibly to the community, may offer advantages of cost and convenience. However, the major responsibility for care should continue to lie with clinicians (either medical oncologists or urologists) with extensive experience in mRCC, assisted by specialist nurses, and working in centres with facilities adequate to monitor efficacy and manage toxicities. That said, the extended survival of patients emphasises the importance of compliance and the long-term prevention, detection and management of side effects. Much of this will take place in the community. There is therefore a need for multidisciplinary working to extend beyond specialist centres to include general practitioners, community nurses and pharmacists. Although this paper focuses on mRCC, many of the considerations discussed are also relevant to the management of more common solid tumours in the era of targeted therapy.

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