Pharmacotherapy options for advanced renal cell carcinoma

Abstract

Introduction: Pharmacotherapy for metastatic renal cell carcinoma (mRCC) has been revolutionized during the last years due to improved understanding of the molecular pathways that underlie tumor development and progression.

Areas covered: This manuscript reviews all the approved drugs for the treatment of mRCC and clinical trials that led to registration and the safety profiles of each molecule. An update of the newer targeted drugs that are currently under investigation, such as cabozantinib and immunologic therapies, is also presented.

Expert opinion: At present, medical oncologists have at least seven agents to treat mRCC; however, progression-free survival and overall survival are still limited and other more personalized therapeutic approaches are needed. In the first-line setting, the COMPARZ and PISCES trials showed that pazopanib presents noninferior efficacy but a better safety profile compared to sunitinib. This could help identify the most suitable drug on the basis of the clinical status of patients. Prospective data support both sequence strategies, tyrosine kinase inhibitor (TKI)-TKI and TKI-mammalian target of rapamycin. Direct comparisons are under investigation and results are awaited. Today, the choice of second-line therapy should be driven by the time on and the efficacy of first-line treatment with a TKI (more or less than 6 months) or by the tolerability profile observed in each patient. New targeted agents such as cabozantinib or new immunotherapy approaches such as programmed death-1/programmed death ligand-1 checkpoint inhibitors will probably enrich the scenario and open other frontiers of treatment.

Keywords::

• clear cell carcinoma
• immunotherapy
• metastatic renal cancer
• mammalian target of rapamycin inhibitors
• tyrosine kinase inhibitor

Notes

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