The cancer of the kidney is a relatively rare Cancer, developing starting from the renal cells.

Epidemiology

The cancer of the kidney accounts for 2 to 3% of the whole of cancers. In 2000, one counted more than 8.000 new cases of cancer of the rein.
The Middle Age of occurred is 62 years and more than 80% of the patients have more than 50 years at the time of the diagnosis.
The cancer of the kidney is twice more frequent at the man than at the woman. (Sex ratio 2.1/1)
The incidence of the cancer of the kidney is, in 2003, of 5.7/100.000 at the woman and 12.2/100.000 inhabitants at the man. She is in regular increase in the industrialized countries, because of improvement of the diagnostic techniques, but probably also because of the changes of lifestyle (increase in the Obésité, of HTA for the two criteria best evaluated).

Risk factors

The independent factors of risk of the cancer of the kidney are the Tabac and the arterial Hypertension. The other known factors are:

• the exposure to derived from oil, heavy metals and asbestos. At June 30th, 2007, the bévacizumab does not have a HEART in the cancer of the metastatic kidney.

Sorafenib

The sorafenib (Nexavar) is the first to have been available by oral way, in July 2006 in France, after having shown, in a broad study comparing it with the interferon alpha, an unambiguous superiority, and a great number of stabilized metastatic diseases. the sorafenib obtained in France the Marketing authorization in " treatment of advanced renal carcinome after failure of a treatment containing interféron esparto or interleukine 2 or among patients for whom these treatments are regarded as inadaptés". In measurement or any study forever shown clear superiority, in profit of total survival for example, cytokines, it is easy to consider them misfit and of being able, thus, to prescribe the sorafenib without awaiting the failure (which is not inevitably immediate nor constant, it is there all the difficulty of the therapeutic choices) of a treatment by interferon.

Sunitinib

The sunitinib (Sutent) involves in particular a rate of objective answers in first line superior to 30%, an increase in survival without progression of the disease and probably a profit of survival compared to former treatments. The sunitinib obtained the Authorization of Setting on Marchéen France in " treatment of advanced cancers of the kidney and/or métastatiques".

Other molecules, belonging to the family of the therapies targeted like the temsirolimus (Toricel°), will be available soon. They have in common an anti-angiogénique, anti-proliferating, sometimes mixed activity. It will be interesting to be able successively to use them in time, or to associate them, in order to extract a maximum of benefit from their respective activity.

Therapeutic strategy

Treatment of the cancer of the kidney localized

Treatment of the cancer of the metastatic kidney

In the absence of possibility of curative treatment, the treatment of the cancer of the metastatic kidney rests on a medical care. in first line:

• interféron
• sunitinib

in second line, after failure of the interféron:

• sorafénib

Follow-up of the patients

The patients operated for a cancer of the kidney must be suivés during 10 years. Each 6 months during 5 years and each year following years. This monitoring must be clinical, biological and radiological.

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