Current systemic management of metastatic renal cell carcinoma - first line and second line therapy.

Objective: The improved understanding of the complex biochemical and genetic pathways associated with renal-cell carcinoma (RCC) has led to rapid development of novel targeted therapies over the last decade. The aim of this review is to present and discuss the most recent clinical trial data that support the currently approved first and second line agents in the treatment of metastatic renal cell carcinoma (mRCC). New directions in treatment will also be explored.

Results: The currently approved first and second line agents for the treatment of mRCC include sunitinib, pazopanib, sorafenib, bevacizumab, temsirolimus, and everolimus. Each of these new agents has shown meaningful clinical benefit in phase III trials and as a group they have replaced cytokines as the frontline therapy for advanced and mRCC. Several new agents are currently being evaluated in phase II and III studies that may provide further benefit in the future.

Conclusions: The treatment paradigm for mRCC had drastically changed over the last decade bringing new hope for improved outcomes and ongoing advances. In spite of recent headway, mRCC remains a disease with no curative therapy and more effective treatment options are needed.