title: Update on the medical treatment of metastatic renal cell carcinoma.
abstract: BACKGROUND
  Metastatic renal cell carcinoma (mRCC) has long been treated only by immunotherapy with good results only in a small population of patients. In recent years, major improvements in treatment possibilities have occurred with the advent of anti-angiogenic drugs. In the past 2 yr, pivotal phase III trials have confirmed this major breakthrough by increasing the progression-free survival rates and/or overall survival rates provided by sunitinib, sorafenib, and bevacizumab, and more recently by the mTOR (mammalian target of rapamycin) inhibitors temsirolimus and everolimus.
  
  
  OBJECTIVE
  To update the previous review on smart drugs published in the European Journal in 2006 (Patard JJ, et al. Understanding the importance of smart drugs in renal cell carcinoma. Eur Urol 2006; 49:633-43).
  
  
  METHODS
  Critical review of published literature 2006-2008 (Pubmed website search words: renal cell carcinoma and/or targeted therapy and prospective trials) and more recent meeting abstracts (American Society of Clinical Oncology 2007). Quality assessment included prospective phase I-III trials and critical evaluations with low numbers of patients, retrospective analyses, and slide presentations of meeting abstracts.
  
  
  RESULTS
  This review presents the current situation and provides more recent data on sequential treatment, the association of targeted drugs, and the treatment of non-clear-cell histologies.
  
  
  CONCLUSIONS
  Treatment of mRCC with targeted therapy centers on at least two major pathways: angiogenesis and mTOR involving inhibiting drugs that may be used alone, in combination, or sequentially.
authors.affiliation: Department of Medical Oncology, Hôpital Saint André, Bordeaux, France; University of Bordeaux 2 Victor Ségalen, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Ravaud
authors.forename: Hervé
authors.initials: H
authors.lastname: Wallerand
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.forename: Patricia
authors.initials: P
authors.lastname: Fergelot
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000378:metabolism / Q000556:secondary*; D015687:Cell Hypoxia / Q000187:drug effects; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A