Abstract

Tyrosine kinase inhibitors (TKIs) are currently the preferred treatment for metastatic renal cell carcinoma (mRCC). However, many urologists are not fully aware of the serious complications of TKI treatment, which require close monitoring. Some clinical and pathological findings associated with TKI treatment may also require further evidence-based characterization, including non-clear cell histology, sarcomatoid differentiation, the role of cytoreductive nephrectomy, and the interactions of other drugs with TKIs. The aim of this review was to provide information the urologists should know before beginning treatment of mRCC with TKIs. A review of all Medline and DOAJ articles related to TKI treatment was undertaken. In this review, 49 publications that were sufficiently relevant and informative were analyzed. As a conclusion, TKIs represent an effective treatment option for patients with metastatic clear cell RCC. TKIs may exhibit favorable effects on metastatic chromophobic RCC; however, no significant effect on metastatic papillary RCC was reported. The currently available data cannot ignore the role of cytoreductive nephrectomy as a prerequisite to the favorable effect obtained through TKI treatment. Neoadjuvant TKIs represent a challenge to anaesthetists and urologists, and special precautions should be taken. Sarcomatoid differentiation of RCCs of clear cell histology may exhibit a favorable response to TKI treatment, provided that prevalence of sarcomatoid cells in the primary tumor is less than 30%.