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Recent Progress in the Management of Advanced Renal Cell Carcinoma

Dr. Garcia is Associate Staff, Departments of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Center; and Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
Dr. Rini is Staff, Departments of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Center; and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.

This article is available online at http://CAonline.AmCancerSoc.org
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Disclosures: Jorge A. Garcia receives research funding from Genentech, Pfizer, and Celgene; Brian I. Rini received research funding from Genentech, Bayer, and Pfizer, and is a paid consultant to Genentech, Bayer, and Pfizer.

A better understanding of the molecular biology of renal cell carcinoma (RCC) has led to a dramatic paradigm shift in the treatment of patients with metastatic disease. Historically, a nonspecific immune approach using cytokines was employed, but recently this has transitioned to a molecularly-targeted approach against vascular endothelial growth factor (VEGF) and related pathways. Several anti-VEGF agents, including ligand-binding agents such as bevacizumab and the small molecule inhibitors of VEGF and related receptors such as sunitinib and sorafenib, have demonstrated clinical activity in patients with metastatic RCC. Other agents that inhibit alternative targets such as the mammalian target of rapamycin (mTOR) have also demonstrated activity. This generation of novel molecular targeted therapies continues to show great promise. The purpose of this review is to summarize the current management and to discuss potential future directions in the management of metastatic RCC.

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