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A survey of therapy for advanced renal cell carcinoma
Urologic Oncology: Seminars and Original Investigations, 07/27/09

Basso M et al. - In a review of therapy for advanced renal cell carcinoma (RCC), the aim of this paper is to review clinical trials with these new agents, describing their activity and profiles of toxicity, and to evaluate potential future developmental strategies.

Methods

RCC is very resistant to both chemotherapy and radiotherapy.
Localized disease can be cured by surgery but most pts are diagnosed when distant metastases are already present and about 30% of pts relapse after nephrectomy.
Until 2 yrs ago, cytokine-based immunotherapy (interleukin-2 and interferon-α) was the only therapeutic option for advanced RCC pts.
<20% of pts benefit from this treatment, but some of these may experience very prolonged complete responses and progression-free intervals, suggesting a possibility of cure in a very few cases.

Results

Thanks to expanding knowledge of the biology and pathogenesis of RCC, treatment of this disease has recently undergone a major advance, through development of potent angiogenesis inhibitors and targeted agents.
Bevacizumab has shown significant activity in combination with interferon-α (IFN-α).
Sunitinib and sorafenib have also been approved for the treatment of this tumor.
Temsirolimus and everolimus have shown some activity in selected pts.

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