Current Treatment Options for Disseminated Renal Cell Carcinoma

Renal cell carcinoma (RCC) is a common urologic tumor and accounts for about 3% of all human malignancies; its incidence has increased steadily in recent decades. Because 40-50% of all RCC patients present with or will develop metastasis, the annual mortality-to-incidence ratio with RCC is significantly higher compared with other urologic malignancies. Only recently, the discovery of specific genetic alterations as well as distinct dysfunctional signal transduction pathways in the different renal cell carcinoma subtypes has enabled the development of innovative targeted drugs. Particularly those agents targeting the vascular endothelial growth factor and mammalian target of rapamycin pathways have revolutionized the treatment of advanced renal cancer. The median tumor-specific overall survival could be at least doubled in only a few years. This review discusses current data on clinical trials evaluating these innovative drugs with a focus on their efficacy in the first-line setting as well as their sequential and combined application. (C) 2012 Published by Elsevier B. V. on behalf of European Association of Urology.