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 an mTOR
(mammalian Target of Rapamycin) inhibitor, while conventional chemotherapeutic and hormonal
treatments do not play a role in the management of mRCC. Several drugs directed against VEGF and VEGFR have been
developed in recent times. Phase III data validates sunitinib, pazopanib and sorafenib as the best-supported drugs in firstline
therapy. Second-line treatment possibilities include 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 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.
Keywords: Renal cancer, targeted therapy, anti-angiogenesis, vascular endothelial growth factor, mammalian Target of
Rapamycin (mTOR), sunitinib, bevacizumab, temsirolimus.
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