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Reshaping Treatment Paradigms for Advanced Renal Cell Cancer Patients and Improving Patient Management

Optimal Management for Renal Cell Cancer Patients

  • Genitourinary Cancers (S Gupta, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The treatment of renal cell carcinoma (RCC) is one of the great success stories in the field of oncology, which was revolutionized with the development of therapies aimed at disrupting crucial pathways. Tumor biology of RCC has provided insight into the disease through elucidation of the role of vascular endothelial growth-factor (VEGF) and the mammalian target of rapamycin (mTOR). Targeted agents against VEGF and mTOR, as well as agents targeting relevant immunomodulatory pathways, have shown clinical benefit for advanced disease. The targeted agents are highly effective in achieving a response and survival, particularly in high-risk patients. These include the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) axitinib and cabozantinib, and programmed cell death 1 protein (PD-1) immune checkpoint inhibitors (ICI) nivolumab and pembrolizumab. There is a wealth of evidence investigating different therapeutic options and combinations for first-line treatment of advanced RCC including the CheckMate 214 study, KEYNOTE-426, JAVELIN Renal 101, and CheckMate 9ER. Dual ICI and combination agents targeting the programmed cell death protein 1/programmed cell death protein ligand 1 (PD1/PDL1) and VEGF, began to demonstrate superiority over previously accepted standards in advanced clear-cell RCC. Data from a number of clinical studies are available to help physicians with evidence-based decisions for the sequence of second-line and future treatments for patients with progressive RCC. In this review, we focus on essentials for clinicians treating patients with clear-cell RCC.

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  1. Department of Internal Medicine, Division of Medical Oncology, Suleyman Demirel University Faculty of Medicine, 32260, Isparta, Turkey

    Bulent Cetin MD

  2. University of California, San Francisco School of Medicine, San Francisco, USA

    Chiara A. Wabl BA

  3. University of California Helen Diller Family Comprehensive Cancer Center, San Francisco, USA

    Ozge Gumusay MD

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  1. Bulent Cetin MD
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Cetin, B., Wabl, C.A. & Gumusay, O. Reshaping Treatment Paradigms for Advanced Renal Cell Cancer Patients and Improving Patient Management. Curr. Treat. Options in Oncol. 23, 609–629 (2022). https://doi.org/10.1007/s11864-022-00966-0

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