title: What is standard initial systemic therapy in metastatic renal cell carcinoma?
abstract: Historically, systemic therapies for metastatic renal cell carcinoma RCC) have met with minimal success. Recently, an improved understanding of cancer biology has been translated into therapies that target pathways critical for RCC growth and survival and produce more robust clinical impact. The risks and benefits of several approaches to systemic therapy in metastatic RCC are reviewed. The need for chronic therapy of novel agents and potential for toxicity raise questions in regard to the timing of therapy and value of combination therapy over sequential single agents. Further insight into the biology of response, resistance, and toxicity is needed to allow for rational patient selection and enhanced application of systemic therapies. As new standard therapies for metastatic RCC emerge, clinical trial conduct remains a priority to further optimize patient outcome.
authors.affiliation: Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Center, OH 44195, USA. rinib2@ccf.org
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.forename: David
authors.initials: D
authors.lastname: McDermott
authors.forename: Michael
authors.initials: M
authors.lastname: Atkins
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary; D016207:Cytokines / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011494:Protein Kinases / Q000187:drug effects*; D058570:TOR Serine-Threonine Kinases; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D016207:Cytokines; D042461:Vascular Endothelial Growth Factor A; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases