title: Present and future therapeutic options for locally advanced and metastatic renal cell carcinoma.
abstract: BACKGROUND
  Locally advanced or metastatic renal cell carcinoma (RCC) is notoriously chemo- and radioresistant, leaving immunotherapy as the only treatment option. In recent years, targeted therapies have offered significant increases in progression-free survival (PFS). Despite this, the majority of patients soon develops resistant disease and finally succumbs. The need to implement treatment strategies that improve overall survival while having an acceptable safety profile is imperative.
  
  
  METHODS
  This review provides information on the efficacy of recently studied treatment strategies for advanced RCC. These include sequential and combination therapy of established drugs as well as data on agents in early clinical development. The Medline and ASCO database were searched for clinical trials on medical therapy of advanced RCC from 2004 until May 2010. Data on targeted therapies, including tyrosine kinase inhibitors, vascular endothelial growth factor inhibitors, mammalian target of rapamycin inhibitors, and antiepidermal growth factor receptor agents are summarized.
  
  
  CONCLUSIONS
  Improvements in response rates and PFS in patients with advanced RCC have been observed with new treatment strategies. The benefit in overall survival is less clear and needs further evaluation. Toxicity represents a concern especially in combination regiments.
authors.affiliation: University of Patras, Patras University General Hospital, Urology, Patras, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Sfoungaristos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Giannitsas
authors.forename: Petros
authors.initials: P
authors.lastname: Perimenis
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D016503:Drug Delivery Systems; D015195:Drug Design; D019008:Drug Resistance, Neoplasm; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D009362:Neoplasm Metastasis; D013534:Survival; D016896:Treatment Outcome