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RENAL CELL CARCINOMA: WHAT DOES THE FUTURE HOLD?

An improved understanding of the biology of RCC has resulted in the development of novel agents that target important pathways involved in angiogenesis and tumour growth. Studies on sunitinib malate [1], sorafenib tosylate [2], temsirolimus [3], and bevacizumab/interferon [4] have shown significant improvements in disease control, progression-free and overall survival (temsirolimus) resulting in regulatory approval of three new therapies for metastatic RCC in as many years. The mechanism of action of these agents are different but overlapping, with variable but generally tolerable side-effects. Various other novel targeted agents (i.e. pazopanib, axitinib, everolimus) are in clinical development. Clearly, the use of these agents has affected the natural history of what has generally been considered a ‘treatment-resistant’ cancer. We are now faced with many of the same therapeutic questions that exist with other ‘treatable’ cancers. How do physicians tailor individual therapy to provide the greatest benefit to patients? Is combined therapy better than sequential use of single agents? Can adjuvant therapy improve cure rates? How can resistance be overcome? As we approach the future, these fundamental questions must be answered to further advance the therapeutic options for RCC.