In the last decades, the treatment of mRCC, metastatic Renal Cell Carcinoma, has become
more and more complex due to the approval of a great number of effective systemic treatments that
have significantly improved the prognosis of patients suffering from such disease. An additional
knowledge of the genetic aberrations and the molecular pathways alterations that underlie RCC, has
promoted the development of several novel agents, known as target therapies (TTs). Even though TTs
are not curative and all patients eventually progress, an adequate sequencing of these drugs can provide
a significant benefit in terms of PFS, Progression Free Survival, and hopefully OS, Overall Survival. To
date, there are few data about the optimal sequential use of the TTs hence, in clinical practice, the
therapeutic strategy is chosen on the basis of the safety profile of the drug, patients medical history and
the pivotal trial results, though such studies often exclude patients with poor performance status and/or
severe comorbidities that we routinely see in our clinics. This review aims to provide an overview of
the systemic therapies for mRCC both in the newly diagnosed patients and in the subsequent lines of
treatment, with a special focus on the last advances about TTs and immunotherapy.
Keywords: Metastatic renal cell cancer, VEGF pathway, mammalian target of rapamycin pathway, first line therapy, immunotherapy,
sequence treatment, new pathway, combination therapy.
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