title: Targeted therapy in renal cell carcinoma.
abstract: OBJECTIVE
  To present an update on anti-angiogenic drugs in the treatment of metastatic renal cell carcinoma.
  
  
  RESULTS
  A better understanding of molecular pathways that are involved in clear cell carcinomas has led to the development of multiple targeted therapies with significant clinical benefits. Two tyrosine kinase inhibitors targeting the vascular endothelial growth factor (VEGF) receptor have been shown to improve the progression-free survival of patients in first-line (Sunitinib vs. interferon-alpha) or second-line treatment (Sorafenib vs. placebo). Temsirolimus, an agent that inhibits the serine-threonine kinase activity of the mammalian target of rapamycin, offers better overall survival than interferon in patients with poor-risk characteristics. Finally, Bevacizumab, which is an antibody directed against VEGF, in association with IFN is providing substantial response rates and increased progression-free survival compared to IFN alone.
  
  
  CONCLUSIONS
  Four major drugs or regimens with proven efficacy are now available in first and second line therapy in metastatic renal cell carcinoma (mRCC). Further studies are needed to determine the optimal combinations of these agents in metastatic disease and to assess their impact in the adjuvant setting.
authors.affiliation: Department of Urology, Rennes University Hospital, CHU Pontchaillou, rue Henri le Guillou, 35033 Rennes, France. jean-jacques.patard@univ-rennes1.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Damien
authors.initials: D
authors.lastname: Pouessel
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
mesh_terms: D020533:Angiogenesis Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D020533:Angiogenesis Inhibitors