From the Guidelines
Medications used to treat renal cancer include tyrosine kinase inhibitors (TKIs) such as sunitinib, sorafenib, pazopanib, and axitinib, as well as mTOR inhibitors like everolimus and temsirolimus.
Targeted Therapies
- TKIs: sunitinib, sorafenib, pazopanib, axitinib, lenvatinib, and cabozantinib are approved for the treatment of metastatic renal cell carcinoma (mRCC) 1
- mTOR inhibitors: everolimus and temsirolimus are approved as single agents in the second-line setting and in the first line in patients with poor risk status 1
Immunotherapies
- nivolumab and ipilimumab are approved for the treatment of patients with intermediate or poor risk, previously untreated aRCC 1
- pembrolizumab in combination with axitinib and avelumab in combination with axitinib are approved for the first-line treatment of patients with aRCC 1
Treatment Selection
- Tumor histology and risk stratification of patients are important in targeted therapy selection 1
- The MSKCC model is a widely used model for risk stratification, which classifies patients according to the presence or absence of 5 adverse prognostic factors 1
Non-clear Cell Renal Cell Carcinoma (non-ccRCC)
- sunitinib, pazopanib, and everolimus are options for the treatment of non-ccRCC 1
- nivolumab and ipilimumab are options for the treatment of sarcomatoid tumors 1
- cMET inhibitors such as crizotinib or cabozantinib may be considered for papillary RCC with cMET mutation or amplification 1
From the Research
Medications for Renal Cancer
The following medications are used to treat renal cancer:
- Tyrosine kinase inhibitors: sorafenib, sunitinib, pazopanib, axitinib, tivozanib, dovitinib, and cediranib 2, 3, 4
- Mammalian target of rapamycin inhibitors: temsirolimus and everolimus 2, 4
- Immunotherapies: bevacizumab, nivolumab 2, 3, 5
- Anti-vascular endothelial growth factor antibody: bevacizumab 3
- Interleukin-2 (IL-2) and interferon-alfa (IFN-alpha) 4
Targeted Therapies
Targeted therapies work by disrupting specific signalling pathways involved in tumour progression, such as those responsible for angiogenesis and cell proliferation 2. These therapies have great potential for disrupting tumour progression by inhibiting certain signalling pathways.
Combination Therapy
Combination targeted therapy has been attempted to improve efficacy, but with either very limited additional efficacy or nontolerable toxicities 3. Recent advances in the molecular understanding of tumor angiogenesis and mechanism of resistance, along with the rapid development of targeted drug discovery, have made it possible to further explore novel combination therapy for RCC 3.
Treatment Selection
Treatment selection for metastatic disease is currently based on histology, prognostic group and patient preference based on side effect profile 5. Clinical prognostic models also have a role in the management of advanced disease, and there is a pressing need for predictive biomarkers to direct therapy 5.