Is There a Role for Neoadjuvant Targeted Therapy to Downsize Primary Tumors for Organ Sparing Strategies in Renal Cell Carcinoma?

Table 1

Pro neoadjuvant therapy	Contra neoadjuvant therapy
(i) Downsizing may allow organ preservation and preservation of renal function in patients with impaired renal function otherwise requiring nephrectomy and dialysis.	(i) The percentage of patients experiencing substantial downsizing with sunitinib or sorafenib is unpredictable.
(ii) Nephron sparing is associated with improved overall survival and reduced morbidity. Downsizing tumors for nephron sparing strategies in patients otherwise requiring nephrectomy may improve long-term survival.	(ii) There are currently no biomarkers predicting local tumor response.
(iii) Case reports and retrospective series suggest that patients with tumors of 5–7 cm in size may have a benefit of downsizing tumors with sunitinib and sorafenib followed by NSS or ablation.	(iii) Primary tumors that can be cured by surgery alone may progress under neoadjuvant therapy.
(iv) The chance to have a marked downsizing in primary tumors of 5–7 cm is substantially higher than for larger tumors.	(iv) Preclinical models suggest an increased metastatic potential of solid tumors after targeted therapy.
	(v) Neoadjuvant therapy may be associated with wound healing impairments.
	(vi) Drug-related adverse events may further delay curative surgery.