Book Review

Clinical Management of Renal Tumors

N Engl J Med 2008; 359:1635October 9, 2008

Article

Clinical Management of Renal Tumors
Edited by Ronald M. Bukowski and Andrew C. Novick. 663 pp., illustrated. Totowa, NJ, Humana Press, 2008. $149. ISBN: 978-1-58829-251-3

Renal-cell carcinoma actually comprises a heterogeneous group of diseases with varying clinical presentations, all of which require a multidisciplinary approach to treatment, with contributions from urologists, pathologists, medical oncologists, radiologists, and nursing staff. The groundwork for the many advances made in renal-cell carcinoma over the past decade has its roots in two seminal laboratory discoveries. The first was the observation in 1979 that a translocation between the short arm of chromosome 3 and the long arm of chromosome 8 affected 8 of 10 members of a family with genes linked to a hereditary form of kidney cancer. The second was the demonstration that the loss of alleles on the short arm of chromosome 3 occurred in all of 11 patients with the sporadic form of this disease. In von Hippel–Lindau (VHL) disease, which is transmitted in an autosomal dominant pattern, neoplastic tumors in multiple organ systems, including the kidney, develop in carriers of a mutant VHL gene on the short arm of chromosome 3. In sporadic clear-cell carcinoma of the kidney, most tumors contain a genetic abnormality similar to the mutant VHL gene.

While the biology of renal-cell carcinoma was unfolding, major progress was being made in the surgical approaches to this disease. Urologic oncologists found that the principal operative procedure for renal cancer, radical nephrectomy, could be replaced by procedures that offered the same chance for cure with less morbidity and better preservation of organ function. The transformation of the surgical approach was pioneered by Andrew Novick, one of the editors of this book.

The confluence of surgery, biology, and a better understanding of the clinical, pathologic, and genetic predictors of recurrence and survival in renal-cell carcinoma led to clinical trials of new targeted agents. As a result, five drugs (sunitinib, temsirolimus, bevacizumab, sorafenib, and everolimus) were shown to be more effective than interferon, to provide the best supportive care after cytokine therapy, or to provide the best supportive care after progression on antiangiogenesis therapy.

Clinical Management of Renal Tumors is comprehensive and timely, bringing together the dramatic changes that have unfolded in the management of this disease. Both of the book's editors were at the heart of the revolution that improved the treatment of renal-cell carcinoma. The weakness of a book like this one is that the field changes so quickly that the editors and authors cannot capture the most recent advances. That, however, is a small price to pay for this excellent resource for patients, families, and practitioners.

Robert A. Figlin, M.D.
City of Hope Comprehensive Cancer Center, Duarte, CA 91010
rfiglin@coh.org