Systemic therapy for patients with advanced, unresectable or metastatic renal cell carcinoma: Moving to guidelines

Until recently, patients with advanced, unresectable or metastatic renal cell cancer (RCC) had very few therapeutic options. Cytokine therapy, consisting mainly of interferon-α and interleukin-2, was considered the mainstay of ther-apy. A better understanding of the biology of RCC has led to the develop-ment of novel therapeutic agents that target angiogenesis. Inactivation of the von Hippel-Lindau tumour-suppressor gene VHL, which is present in the vast majority of clear-cell RCC tumours, leads to overexpression of the vascular endothelial growth factor, which in turn promotes angiogenesis. Recent obser-vations from a number of positive studies with agents such as sunitinib malate, sorafenib, temsirolimus and bevacizumab have led to a rapid and exciting change in the standard of care for patients with advanced renal cell carcino-ma. This article reviews these agents in the context of their use in clinical prac-tice and provides suggestions about the appropriateness of various agents in specific clinical situations. © 2007 Canadian Urological Association.