title: Targeted therapies in the management of renal cell carcinoma: role of bevacizumab.
abstract: Bevacizumab (10 mg/kg every 2 weeks), in combination with interferon alpha-2a (IFN), is an effective option for first-line therapy for advanced and/or metastatic renal cell carcinoma (RCC). Two phase III trials clearly show significant improvements in progression-free survival and response rate in patients with treatment-naïve metastatic RCC receiving bevacizumab combined with IFN compared with IFN. The dose of IFN, which was initiated at 9 MIU 3 times a week in these trials, can be reduced to effectively manage IFN-related side effects without compromising the efficacy of bevacizumab plus IFN. Bevacizumab has good tolerability with manageable side effects, both alone and in combination with other agents; the tolerability profile of bevacizumab in combination with IFN is consistent with the well-characterized and well-established profiles of these therapies. The tolerability of bevacizumab combined with IFN and the flexibility to manage IFN-related side effects are important considerations when selecting first-line therapy. With a number of options now available for RCC therapy, optimizing their use is a key consideration in improving patient benefit.
authors.affiliation: Unité Immunothérapie, Institut Gustave Roussy, Villejuif, France;
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Jan
authors.initials: J
authors.lastname: Cosaert
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Jethwa
references.citation: BJU Int. 2008 Apr;101(8):949-58
references.pmid: 18241251
references.citation: J Urol. 2006 Dec;176(6 Pt 1):2353-8
references.pmid: 17085101
references.citation: Biochimie. 2007 Jun-Jul;89(6-7):884-93
references.pmid: 17532550
references.citation: J Urol. 2003 Dec;170(6 Pt 1):2163-72
references.pmid: 14634372
references.citation: BJU Int. 2007 May;99(5 Pt B):1282-8
references.pmid: 17441925
references.citation: N Engl J Med. 2003 Jul 31;349(5):419-21
references.pmid: 12890838
references.citation: Br J Cancer. 2003 Jun 16;88(12):1979-86
references.pmid: 12799646
references.citation: Nature. 1993 Apr 29;362(6423):841-4
references.pmid: 7683111
references.citation: Clin Cancer Res. 2007 Jan 15;13(2 Pt 2):764s-769s
references.pmid: 17255307
references.citation: Cancer. 2007 Dec 1;110(11):2468-77
references.pmid: 17932908
references.citation: Lancet. 2007 Dec 22;370(9605):2103-11
references.pmid: 18156031
references.citation: J Clin Oncol. 2007 Oct 10;25(29):4536-41
references.pmid: 17876014
references.citation: N Engl J Med. 2006 Dec 14;355(24):2542-50
references.pmid: 17167137
references.citation: N Engl J Med. 2004 Jun 3;350(23):2335-42
references.pmid: 15175435
references.citation: Am J Surg Pathol. 2003 May;27(5):612-24
references.pmid: 12717246
references.citation: Biochem Biophys Res Commun. 1989 Jun 15;161(2):851-8
references.pmid: 2735925
references.citation: Ann Oncol. 2008 Aug;19(8):1470-1476
references.pmid: 18408224
references.citation: Clin Cancer Res. 2007 Jan 15;13(2 Pt 2):680s-684s
references.pmid: 17255293
references.citation: Clin Cancer Res. 2004 Sep 15;10(18 Pt 2):6367S-70S
references.pmid: 15448032
references.citation: Cancer Res. 2001 Jul 1;61(13):5090-101
references.pmid: 11431346
references.citation: J Clin Oncol. 2007 Aug 1;25(22):3296-301
references.pmid: 17664477
references.citation: J Clin Oncol. 2007 Aug 1;25(22):3288-95
references.pmid: 17664476
references.citation: J Clin Oncol. 2009 Mar 20;27(9):1432-9
references.pmid: 19224847
references.citation: J Clin Oncol. 2006 Dec 10;24(35):5593-600
references.pmid: 17158545
references.citation: J Clin Oncol. 1999 Sep;17(9):2859-67
references.pmid: 10561363
references.citation: N Engl J Med. 1996 Sep 19;335(12):865-75
references.pmid: 8778606
references.citation: J Exp Med. 1971 Feb 1;133(2):275-88
references.pmid: 4332371
references.citation: J Clin Oncol. 2006 Dec 10;24(35):5576-83
references.pmid: 17158543
references.citation: BJU Int. 2007 May;99(5 Pt B):1223-9
references.pmid: 17441915
references.citation: Clin Genitourin Cancer. 2009 Jan;7(1):24-7
references.pmid: 19213664
references.citation: J Clin Oncol. 2004 Jun 1;22(11):2184-91
references.pmid: 15169807
references.citation: N Engl J Med. 2007 Dec 27;357(26):2666-76
references.pmid: 18160686
references.citation: Ann Oncol. 2008 Apr;19(4):631-40
references.pmid: 18281267
references.citation: Science. 1983 Feb 25;219(4587):983-5
references.pmid: 6823562
references.citation: J Clin Oncol. 2001 Feb 1;19(3):843-50
references.pmid: 11157038
references.citation: N Engl J Med. 2007 Jan 11;356(2):115-24
references.pmid: 17215529
references.citation: Oncologist. 2001;6(1):34-55
references.pmid: 11161227
references.citation: Science. 1989 Dec 8;246(4935):1306-9
references.pmid: 2479986
references.citation: N Engl J Med. 2003 Jul 31;349(5):427-34
references.pmid: 12890841
references.citation: J Clin Oncol. 2004 Feb 1;22(3):454-63
references.pmid: 14752067
references.citation: J Clin Invest. 1995 Apr;95(4):1789-97
references.pmid: 7535799
references.citation: Cancer Res. 2004 Jun 1;64(11):3731-6
references.pmid: 15172975
references.citation: ScientificWorldJournal. 2007 Apr 09;7:837-49
references.pmid: 17619768
references.citation: Ann Oncol. 2007 Mar;18(3):581-92
references.pmid: 17287242
references.citation: Nat Med. 1998 Mar;4(3):336-40
references.pmid: 9500609
references.citation: Endocr Rev. 2004 Aug;25(4):581-611
references.pmid: 15294883
references.citation: Crit Rev Oncol Hematol. 2007 Dec;64(3):247-62
references.pmid: 17662611
references.citation: N Engl J Med. 1971 Nov 18;285(21):1182-6
references.pmid: 4938153
references.citation: CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
references.pmid: 18287387
references.citation: Nature. 1996 Apr 4;380(6573):435-9
references.pmid: 8602241
references.citation: Lancet. 1999 Jan 2;353(9146):14-7
references.pmid: 10023944
references.citation: Nat Med. 2003 Jun;9(6):669-76
references.pmid: 12778165
references.citation: Nat Med. 2004 Feb;10(2):145-7
references.pmid: 14745444
references.citation: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001425
references.pmid: 15674877
references.citation: J Clin Invest. 2006 Oct;116(10):2610-21
references.pmid: 17016557
references.citation: Cancer Res. 1997 Oct 15;57(20):4593-9
references.pmid: 9377574
references.citation: Oncology. 2005;69 Suppl 3:4-10
references.pmid: 16301830
references.citation: Cancer Res. 1986 Nov;46(11):5629-32
references.pmid: 3756910
references.citation: Growth Factors. 1992;7(1):53-64
references.pmid: 1380254
references.citation: J Cancer Res Clin Oncol. 1998;124(3-4):141-7
references.pmid: 9619739
references.citation: Semin Oncol. 2002 Dec;29(6 Suppl 16):3-9
references.pmid: 12516032
references.citation: J Clin Oncol. 2003 Jan 1;21(1):60-5
references.pmid: 12506171
references.citation: Eur J Cancer. 2008 Jul;44(10):1345-89
references.pmid: 18280139
references.citation: J Clin Oncol. 2006 Dec 10;24(35):5584-92
references.pmid: 17158544
references.citation: Semin Oncol. 2000 Apr;27(2):187-93
references.pmid: 10768597
references.citation: Biochem Biophys Res Commun. 2005 Jul 29;333(2):328-35
references.pmid: 15961063
references.citation: Biochem Biophys Res Commun. 2005 Dec 9;338(1):627-38
references.pmid: 16153592
references.citation: N Engl J Med. 2007 Jan 11;356(2):125-34
references.pmid: 17215530
references.citation: J Clin Oncol. 2002 Jan 1;20(1):289-96
references.pmid: 11773181
references.citation: J Clin Oncol. 2001 Feb 1;19(3):851-6
references.pmid: 11157039
references.citation: BJU Int. 2004 Feb;93(3):297-302
references.pmid: 14764126
references.citation: Pathology. 2007 Oct;39(5):459-65
references.pmid: 17886093
references.citation: FASEB J. 2000 Dec;14(15):2373-6
references.pmid: 11024009
references.citation: Eur Urol. 2007 Jun;51(6):1502-10
references.pmid: 17408850
references.citation: Nat Med. 1999 Jun;5(6):623-8
references.pmid: 10371499