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  • Review Article
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Treatment of metastatic renal cell carcinoma

Abstract

The median survival of patients with metastatic renal cell carcinoma (mRCC) has increased from 10 months to more than 40 months since the advent of targeted therapy. Sunitinib and bevacizumab represent the first-line standards of care for patients with clear cell mRCC. Temsirolimus is the standard of care for those with poor-risk features. Additionally, exploratory analyses of the temsirolimus data indicate important benefits for those with non-clear-cell mRCC. Everolimus has proved its efficacy in second-line therapy. Sunitinib and sorafenib are also effective for non-clear-cell histological subtypes and after failure of first-line treatment. Potential survival benefits can also be derived from cytoreductive nephrectomy (CNT) in patients previously exposed to sunitinib or bevacizumab. Phase III studies are ongoing to address the importance of CNT in the targeted therapy era. Such information is crucial to ensure timely delivery of a combination of medical and surgical therapies to this patient population.

Key Points

  • Sunitinib and bevacizumab represent first-line standards of care for patients with clear cell metastatic renal cell carcinoma

  • Everolimus represents a second-line standard of care

  • Additional progression-free survival benefits might be derived from cytoreductive nephrectomy, while we await the results of ongoing phase III trials

  • Sequential use of targeted therapies can improve progression-free survival and overall survival

  • Temsirolimus, sunitinib and sorafenib are effective for non-clear-cell cancers

  • The efficacy and tolerability of targeted therapies in the elderly are generally similar to those observed in their younger counterparts

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Figure 1: Molecular pathways responsible for RCC.

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Acknowledgements

P. I. Karakiewicz is partially supported by the University of Montreal Health Center Urology Specialists, Fonds de la Recherche en Santé du Quebec, the University of Montreal Department Of Surgery and the University of Montreal Health Center (CHUM) Foundation.

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Correspondence to Pierre I. Karakiewicz.

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Sun, M., Lughezzani, G., Perrotte, P. et al. Treatment of metastatic renal cell carcinoma. Nat Rev Urol 7, 327–338 (2010). https://doi.org/10.1038/nrurol.2010.57

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