The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors

PURPOSE OF REVIEW: To give insight into the current literature on feasibility, safety and outcome of presurgical targeted molecular therapies (TMTs) before nephron-sparing surgery (NSS) in patients with renal cell carcinoma. RECENT FINDINGS: Presurgical TMTs have been proven to be effective and well tolerated for patients with previously unresectable primary tumors and known metastatic disease. Current evidence suggests that this also is true for patients with bulky tumors not amenable to NSS, but with imperative indications for NSS like solitary kidney, bilateral tumors, pre-existing chronic kidney disease, or tumor predisposing syndromes. TMT is generally well tolerated in this regimen and complication rates around surgery are low when TMT is withheld around the half-life time of the agent used. SUMMARY: In selected cases, TMT before NSS is well tolerated, effective and feasible. Still, this topic is considered experimental because it has not been thoroughly studied to fully assess the indications, the timing of therapy, and its effect on outcomes. Further evidence is needed to draw definitive conclusions.