Which Way Should be Chosen for Treatment of Metastatic Renal Cell Carcinoma?

There are two major pathways targeted for the treatment of metastatic renal cell cancer. One is VEGF inhibition that induces tumor shrinkage and increases progression-free survival and the other is Immune checkpoint inhibition that has been shown to increase overall survival. There are two clinically possible ways to block the antiangiogenic (VEGF) pathway. We can use Tyrosine kinase inhibitors (Sunitinib, Pazopanib, Cabozantinib, Axitinib, Sorafenib) that block the intracellular domain of the VEGFR or a monoclonal antibody (Bevacizumab) that binds to circulating VEGF and prevents it from activating VEGFR [1]. Checkpoint inhibition targeting the T lymphocyte-associated antigen 4 (CTLA-4) and/or programmed cell death receptor 1 (PD-1) pathway has led to significant improvements in the treatment of many malignancies, including renal cell carcinoma.