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Optimal management of metastatic renal cell carcinoma: an algorithm for treatment
Author(s) -
Bellmunt Joaquim,
Flodgren Per,
Roigas Jan,
Oudard Stéphane
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08563.x
Subject(s) - temsirolimus , sunitinib , medicine , sorafenib , tolerability , renal cell carcinoma , bevacizumab , oncology , context (archaeology) , targeted therapy , refractory (planetary science) , everolimus , cancer , intensive care medicine , adverse effect , discovery and development of mtor inhibitors , chemotherapy , hepatocellular carcinoma , apoptosis , paleontology , biochemistry , chemistry , protein kinase b , physics , biology , astrobiology
The treatment of metastatic renal cell carcinoma (mRCC) has been changed by the introduction of targeted agents. Consideration of individual patient factors, such as previous treatment and prognostic risk, e.g. according to the Memorial Sloan‐Kettering Cancer Center (MSKCC) risk criteria), can assist in ensuring that patients receive appropriate targeted therapies. Available clinical evidence shows sunitinib to be the reference standard of care for the first‐line treatment of mRCC in patients at favourable or intermediate prognostic risk according to MSKCC criteria. Combined treatment with bevacizumab plus interferon‐α can also be considered for the first‐line treatment of mRCC in this setting. For the first‐line treatment of poor‐risk patients, temsirolimus has shown benefit in a phase III study, while sunitinib can also be considered. For second‐line treatment in cytokine‐refractory patients, sorafenib is recommended based on phase III trial results; sunitinib has also shown activity after failure of cytokine therapy or targeted agents. As well as antitumour activity, the tolerability of targeted agents should be evaluated in the context of individual patients, considering factors such as comorbidities and age. As our understanding of the activity of targeted agents for mRCC increases, we should ensure that these agents are used appropriately to provide patients with optimal treatment benefits.