Renal and Adrenal cancer: Clinical Course, Nanomedicine, Relapse and Optimal Management of Adrenal Metastases using Artificial Intelligence and Virtual Reality methods

Advanced renal cancer poses a life threat. Most likely it represents a renal cell carcinoma, metastasis and adrenal gland metastasis with direct clinical course. The renal metastases may pose resistance to immunotherapy with only option of local therapy and surgery left. Molecular profiling, next-generation sequencing, tumor mutation burden testing of PBRM1, SETD2 and VHL mutations, genomic BAP1, PD-L1 profiling and apoptosis biomarkers characterize the renal and adrenal metastases; 2. Artificial intelligence algorithms for better tumor classification and monitoring treatment response after chemotherapy, radiation and surgery interventions. New therapeutic genomic agents and nanochemoprevention are more effective theranostic options. In more advanced therapeutic resistant lesions, ablation therapy is choice after immunotherapy of both renal and adrenal metastases either relapse or remained residual disease. Management with local therapy, interleukin-2 therapy in relapsed lesions, immune-check point inhibitor therapy and antivascular therapy may induce durable remissions. Artificial intelligence, virtual reality and robotic methods are emerging.