Current and Future Treatment Options for Metastatic Renal Cell Carcinoma

Context: Metastatic renal cell carcinoma (mRCC) is associated with poor survival, and until recently, treatment options have been very limited. However, the advent of targeted therapies has radically improved the outlook for patients with mRCC. Objective: This review describes current treatment options for mRCC and summarizes the data on efficacy and safety of approved and newly emerging targeted therapies. Evidence acquisition: Medical literature was retrieved from PubMed during January 2009. Additional relevant articles were included from the bibliographies of retrieved literature. Evidence synthesis: There continues to be a role for surgery and immunotherapy in mRCC, but this role is limited to specific patient subgroups. Several pivotal, phase 3 trials have established the efficacy and tolerability of agents targeting the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways in various clinical settings. The benefit of everolimus after failure of VEGF-targeted therapy in the phase 3 RECORD-1 trial has demonstrated the value of sequential treatment for patients with mRCC. Other sequential regimens as well as the combination of targeted agents with each other or with immunotherapy are all promising approaches warranting further investigation. There may also be a potential role for targeted agents in both the neoadjuvant and adjuvant settings. Conclusions: The development of targeted therapies for mRCC has substantially improved the treatment options for patients. The results of further studies that will enable the optimal integration of targeted agents into treatment strategies for mRCC are awaited with interest. # 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.