The current paradigm in attempting to treat metastatic renal cell carcinoma (mRCC) is a first line treatment with a vascular endothelial growth factor (VEGF) antagonist and second and subsequent treatments with either a vascular endothelial growth factor receptor (VEGFR) or a mTOR (mammalian Target of Rapamycin) inhibitor, while conventional chemotherapeutic and hormonal treatment do not play a role in the management of mRCC. Several drugs directed against VEGF and VEGFR have been developed in recent times. Based on phase III data, sunitinib, pazopanib and sorafenib represent the best-supported drugs in first-line therapy. Second-line treatment possibilities are axitinib, everolimus and sorafenib. Choosing the right combination of first and second line treatments, however, is difficult, because the success of treatment depends on the individual precondition of the patient.
Hence, biomarkers indicating the best choice of therapy in individual patients are searched and newer trials are set to determine the role of surgery and vaccination together with anti-angiogenic drugs in the treatment of mRCC. In this review, current guidelines in mRCC management are summarized and possibilities of future personalized therapies are pointed out