Korean J Urol.  2012 Apr;53(4):217-228.

Current Status of Targeted Therapy for Advanced Renal Cell Carcinoma

• Cho IC
• Chung J

Abstract

The treatment of metastatic renal cell carcinoma (mRCC) has recently evolved from being predominantly cytokine-based treatment to the use of targeted agents, which include sorafenib, sunitinib, bevacizumab (plus interferon alpha [IFN-alpha]), temsirolimus, everolimus, pazopanib, and most recently, axitinib. Improved understanding of the molecular pathways implicated in the pathogenesis of RCC has led to the development of specific targeted therapies for treating the disease. In Korea, it has been 5 years since targeted therapy became available for mRCC. Thus, we now have broader and better therapeutic options at hand, leading to a significantly improved prognosis for patients with mRCC. However, the treatment of mRCC remains a challenge and a major health problem. Many questions remain on the efficacy of combination treatments and on the best methods for achieving complete remission. Additional studies are needed to optimize the use of these agents by identifying those patients who would most benefit and by elucidating the best means of delivering these agents, either in combination or as sequential single agents. Furthermore, numerous ongoing research activities aim at improving the benefits of the new compounds in the metastatic situation or their application in the early phase of the disease. This review introduces what is currently known regarding the fundamental biology that underlies clear cell RCC, summarizes the clinical evidence supporting the benefits of targeted agents in mRCC treatment, discusses survival endpoints used in pivotal clinical trials, and outlines future research directions.

Keyword

Molecular targeted therapy; mTOR protein; Renal cell carcinoma; Vascular endothelial growth factor A

MeSH Terms

Antibodies, Monoclonal, Humanized
Biology
Carcinoma, Renal Cell
Hand
Humans
Imidazoles
Indazoles
Indoles
Interferon-alpha
Korea
Molecular Targeted Therapy
Niacinamide
Phenylurea Compounds
Prognosis
Pyrimidines
Pyrroles
Sirolimus
Sulfonamides
TOR Serine-Threonine Kinases
Vascular Endothelial Growth Factor A
Bevacizumab
Everolimus
Antibodies, Monoclonal, Humanized
Carcinoma, Renal Cell
Imidazoles
Indazoles
Indoles
Interferon-alpha
Niacinamide
Phenylurea Compounds
Pyrimidines
Pyrroles
Sirolimus
Sulfonamides
TOR Serine-Threonine Kinases
Vascular Endothelial Growth Factor A

Figure

• 

  FIG. 1 Biological pathways and therapeutic targeted agents for renal cell carcinoma. Reprinted from Rini BI, Atkins MB, Lancet Oncol 2009;10:992-1000, with permission of Elsevier [28].

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