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New systemic treatment options for metastatic renal‐cell carcinoma in the era of targeted therapies
Author(s) -
TAN Thean Hsiang,
PRANAVAN Ganesalingam,
HAXHIMOLLA Hodo Z,
YIP Desmond
Publication year - 2010
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/j.1743-7563.2010.01277.x
Subject(s) - medicine , temsirolimus , sunitinib , sorafenib , targeted therapy , renal cell carcinoma , systemic therapy , everolimus , context (archaeology) , oncology , bevacizumab , kidney cancer , clinical trial , cancer , chemotherapy , discovery and development of mtor inhibitors , pi3k/akt/mtor pathway , breast cancer , hepatocellular carcinoma , apoptosis , paleontology , biochemistry , chemistry , biology
Advances in understanding the biology and genetics of renal‐cell carcinomas have led to the development of novel targeted therapies for the treatment of metastatic renal‐cell cancer. Previously the systemic approaches were limited to cytokine therapies that were modest in their clinical benefits and at the expense of significant toxicities. Investigational treatments with allogeneic bone marrow transplantation were equally toxic and resulted in significant morbidity and mortality. The development of targeted therapy has revolutionized the treatment of metastatic renal‐cell cancer with more meaningful outcomes. This review aims to provide a detailed discussion of the clinical benefits of targeted therapies such as sunitinib, sorafenib, temsirolimus, everolimus, bevacizumab, and some of the newer agents in clinical trial development. The efficacy of these compounds in terms of response, survival and clinical benefit are explored as well as their toxicities. The role of surgery in metastatic renal‐cell carcinoma is reviewed in the context of cytoreductive therapy and resection of solitary and oligometastatic disease. Ongoing studies in the adjuvant setting following curative resection are also reviewed. The availability of targeted therapies has led to their rapid adoption as frontline therapy over traditional cytokine therapy, thus bringing more optimistic and hopeful therapeutic options in a condition where historically, systemic treatments have been relatively unsatisfactory and disappointing.