title: Novel agents for renal cell carcinoma require novel selection paradigms to optimise first-line therapy.
abstract: First-line therapies available for metastatic renal cell carcinoma (RCC) have increased rapidly with the recent introduction of three novel agents: sunitinib, temsirolimus and bevacizumab (in combination with interferon [IFN]). This expansion means that the selection of the optimal therapy for individual patients has become more difficult and increasingly important. A treatment algorithm based on tumour histology and patient risk status is currently used to guide clinical practice, but does not always allow specific treatment for individual patients to be identified. This is particularly true for the largest group of patients, who have favourable or intermediate risk clear cell RCC. Considerations guiding treatment selection for these patients include: potential for cure; and optimal progression-free survival (PFS) with good tolerability and quality of life. In patients who have a realistic opportunity for cure, bevacizumab combined with IFN might be the treatment of choice. However, sunitinib and bevacizumab combined with IFN produce similar PFS. Thus, if optimal PFS is the treatment goal, other factors must be considered. These include patient-related factors such as the needs, circumstances and comorbidities of individual patients and the associated side effects of bevacizumab combined with IFN and sunitinib. More data are currently available to support treatment decisions based on the latter and these are considered in detail, highlighting factors that may lead to selection of bevacizumab combined with IFN or sunitinib in individual patients.
authors.affiliation: Department of Medicine I and Cancer Center, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Manuela
authors.initials: M
authors.lastname: Schmidinger
authors.forename: Christoph C
authors.initials: CC
authors.lastname: Zielinski
mesh_terms: D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary; D002318:Cardiovascular Diseases / Q000139:chemically induced; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D004311:Double-Blind Method; D017277:Drug Approval; D015195:Drug Design; D005060:Europe; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007372:Interferons / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010166:Palliative Care; D018579:Patient Selection; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077210:Sunitinib; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000068258:Bevacizumab; C401859:temsirolimus; D007372:Interferons; D000077210:Sunitinib; D020123:Sirolimus