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J Oncol Pract. 2017 Jul;13(7):414-421. doi: 10.1200/JOP.2017.020909.

Renal Medullary Carcinoma: Establishing Standards in Practice.

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Vanderbilt University Medical Center, Nashville; St Jude Children's Research Hospital, Memphis, TN; University of Texas MD Anderson Cancer Center; Baylor College of Medicine, Houston, TX; American University of Beirut Medical Center, Beirut, Lebanon; Université Paris-Est Créteil, Créteil; Institut Curie; University Pierre and Marie Curie, Paris, France; University of North Carolina at Chapel Hill, Chapel Hill, NC; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Johns Hopkins University, Baltimore, MD; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium.


Although renal medullary carcinoma (RMC) is a rare subtype of kidney cancer, it is particularly devastating in that it is nearly uniformly lethal. No established guidelines exist for the diagnosis and management of RMC. In April 2016, a panel of experts developed clinical guidelines on the basis of a literature review and consensus statements. The goal was to propose recommendations for standardized diagnostic and management approaches and to establish an international clinical registry and biorepository for RMC. Published data are limited to case reports and small retrospective reviews. The RMC Working Group prepared recommendations to inform providers and patients faced with a low level of medical evidence. The diagnosis of RMC should be considered in all patients younger than 50 years with poorly differentiated carcinoma that arises from the renal medulla. These patients should be tested for sickle cell hemoglobinopathies, and if positive, SMARCB1/INI1 loss should be confirmed by immunohistochemistry. The majority of patients with RMC are diagnosed with metastatic disease. Upfront radical nephrectomy should be considered in patients with good performance status and low metastatic burden or after response to systemic therapy. Currently, cytotoxic, platinum-based chemotherapy provides the best, albeit brief, palliative clinical benefit. Vascular endothelial growth factor-directed therapies and mammalian target of rapamycin inhibitors are ineffective in RMC as monotherapy. Therapeutic trials of novel agents are now available for RMC, and every effort should be made to enroll patients in clinical studies.

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