Metastatic renal cell carcinoma and its treatments

Abstract

The treatment of metastatic renal cell carcinoma is deeply evolving. After the cytokines, interleukin 2 and interferon era, which raised great expectations followed by deep disillusions (related to an efficacy limited to a small group of patients and an important toxicity for a majority of them), the time of targeted therapies has come. These new therapies mainly work on the VHL-HIF way, which controls several key molecules involved in the tumour angiogenesis phenomena, especially the VEGF. Several drugs currently being developed allow to stop either the circulating angiogenic factors (mainly the VEGF), or the tyrosine kinase receptors, especially the VEGF and the PDGF receptors. The reported activity and potential of these drugs are: tumour reduction, improvement of progression-free survival, effects on the overall survival. Currently, 4 among these drugs are in phase III (sorafenib, sunitinib, bevacizumab and temsirolimus), sorafenib and sunitinib have been allowed by the FDA, in the USA, and by the EMEA, in Europe, in the treatment of advanced renal cell carcinoma.