Current Strategy in the Treatment of Metastatic Renal Cell Carcinoma

Alain      Ravaud; Marie-Sarah      Dilhuydy; Aimery      Huchet; Stephane      Pedeboscq; Jean-Philippe      Maire

Abstract

The strategy in the treatment of metastatic renal cell carcinoma (MRCC) is based on prognostic factors for survival. General performance status, delay from the diagnosis of primary tumor to occurrence of metastases, number of metastatic sites or site of metastases (lung, liver) and biological changes such as hemoglobin value, calcium value, and sedimentation rate are reported as the most predictive factors for survival. The first line of treatment in MRCC is immunotherapy for the majority of patients. Disagreement remains regarding the choice of immunotherapy: interleukin-2 (IL-2) and/or interferon alpha; and the mode of administration of IL-2: intravenous or subcutaneous route. Major therapeutic changes are coming with new drugs directed against new targets. Bevacizumab, an anti-Vascular Endothelial Growth Factor (VEGF) has been approved in second-line treatment. Other compounds are under investigation such as drugs targeting the EGF and Ras pathways.

Keywords: biphosphonates, immunotherapy, anti-angiogenic therapy, metastatic sites, nephrectomy, fluorouracile, cardiac toxicity, antitumoral activity, interferon (ifn)