title: Metastatic renal cell carcinoma management.
abstract: OBJECTIVE
  To assess the current treatment of metastatic renal cell carcinoma, focusing on medical treatment options.
  
  
  METHODS
  The most important recent publications have been selected after a literature search employing PubMed using the search terms: advanced and metastatic renal cell carcinoma, anti-angiogenesis drugs and systemic therapy; also significant meeting abstracts were consulted.
  
  
  RESULTS
  Progress in understanding the molecular basis of renal cell carcinoma, especially related to genetics and angiogenesis, has been achieved mainly through of the study of von Hippel-Lindau disease. A great variety of active agents have been developed and tested in metastatic renal cell carcinoma (mRCC) patients. New specific molecular therapies in metastatic disease are discussed. Sunitinib, Sorafenib and Bevacizumab increase the progression-free survival when compared to therapy with cytokines. Temsirolimus increases overall survival in high-risk patients. Growth factors and regulatory enzymes, such as carbonic anhydrase IX may be targets for future therapies.
  
  
  CONCLUSIONS
  A broader knowledge of clear cell carcinoma molecular biology has permitted the beginning of a new era in mRCC therapy. Benefits of these novel agents in terms of progression-free and overall survival have been observed in patients with mRCC, and, in many cases, have become the standard of care. Sunitinib is now considered the new reference first-line treatment for mRCC. Despite all the progress in recent years, complete responses are still very rare. Currently, many important issues regarding the use of these agents in the management of metastatic renal cancer still need to be properly addressed.
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Université Rene Descartes, Paris V, Paris, France. flavio.lobo@gmail.com
authors.forename: Flavio L
authors.initials: FL
authors.lastname: Heldwein
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Gordon
authors.initials: G
authors.lastname: Smyth
authors.forename: Carlos A V
authors.initials: CA
authors.lastname: Souto
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000188:drug therapy* / Q000556:secondary*; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary; D009392:Nephrectomy
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents