{'fraction_non_alphanumeric': 0.02440264361972547, 'fraction_numerical': 0.005083884087442806, 'mean_word_length': 5.348387096774194, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Advanced renal cell carcinoma in Australia, 2015: What should we do?

Once again, we find ourselves at an interesting juncture in the treatment of advanced renal cell carcinoma (aRCC) in Australia. Everolimus (Afinitor, Novartis) is now reimbursed under the Pharmaceutical Benefits Scheme for stage IV clear cell variant aRCC following first-line treatment with a tyrosine kinase inhibitor in patients with performance status 2 or less. Interestingly, this is one of the few examples where the reimbursement indication is less stringent than the registration indication approved by the Therapeutic Goods Administration, reflecting the rapid movement of the field over the last few years. It was only a little over 7 years ago that no effective therapies were available for aRCC in Australia. Interferon was being used in selected centers, either as a single agent or in combination with vinblastine; a few groups used low-dose interleukin-2 (IL-2); and high-dose IL-2 has not been used in Australia for aRCC. Sorafenib, sunitinib, pazopanib and bevacizumab with interferonα2a were approved in fairly rapid succession for treatment of favorableor intermediate-risk aRCC, mainly on the basis of clinical trials showing benefits in progressionfree survival. These approaches take advantage of the frequent dependence of aRCC on signaling through the vascular endothelial growth factor (VEGF) receptor (VEGFR) and similar or related pathways. Temsirolimus targets the mammalian target of rapamycin (mTOR) pathway and was approved for poor-risk patients on the basis of the only trial to date to show a survival advantage, although subsequent analyses of previous trials purported to demonstrate improved survival for other agents also. Everolimus (mTOR inhibitor) and axitinib (VEGFR inhibitor) are approved in Australia for secondline treatment of aRCC. This apparent wealth of treatments has now raised several new issues that clinicians and our patients must consider.