Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update.

PURPOSE: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil. METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence. RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease. CONCLUSION: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.

Treatment of ovarian cancer beyond chemotherapy: are we hitting the target?

Ovarian cancer (OC) is the sixth most common cancer worldwide among women, and, in developed countries, it is the leading cause of mortality among gynecological malignancies. With an overall cure rate of <40% across all stages, it comprises a variety of tumors with different histopathological features and biological behavior. Nowadays, OC is considered a general term that designates a group of molecularly and etiologically distinct diseases that share an anatomical location. Approximately 70-80% of patients with OC will relapse after first-line chemotherapy, and the majority of them will eventually die of chemotherapy-resistant disease. Until now, the management of relapsed OC remains an unmet medical need. Therapy rather depends on tumor stage and grade than on histological type, but there is growing evidence that, as epithelial OC is a heterogeneous disease, it needs a tailored approach based on the underlying molecular genetic changes. Several phase III studies investigating targeted therapies are underway, and a more individual approach for treating OC will be selected in the future. The purpose of this paper was to review the literature in order to highlight available data emerging from trials and to evaluate efficacy and safety of molecularly targeted drugs in OC.