title: ICUD-EAU International Consultation on Kidney Cancer 2010: treatment of metastatic disease.
abstract: BACKGROUND
  Until the development of novel targeted agents directed against angiogenesis and tumour growth, few treatment options have been available for the treatment of metastatic renal-cell carcinoma (mRCC).
  
  
  OBJECTIVE
  This review discusses current targeted therapies for mRCC and provides consensus statements regarding treatment algorithms.
  
  
  METHODS
  Medical literature was retrieved from PubMed up to April 2011. Additional relevant articles and abstract reviews were included from the bibliographies of the retrieved literature.
  
  
  RESULTS
  Targeted treatment for mRCC can be categorized for the following patient groups: previously untreated patients, those refractory to immunotherapy, and those refractory to vascular endothelial growth factor (VEGF)-targeted therapy. Sunitinib and bevacizumab combined with interferon alpha are generally considered first-line treatment options in patients with favourable or intermediate prognoses. Temsirolimus is considered a first-line treatment option for poor-risk patients. Either sorafenib or sunitinib may be valid second-line treatments for patients who have failed prior cytokine-based therapies. For patients refractory to treatment with VEGF-targeted therapy, everolimus is now recommended. Pazopanib is a new treatment option in the first- and second-line setting (after cytokine failure). Sequential and combination approaches, and the roles of nephrectomy and tumour metastasectomy will also be discussed.
  
  
  CONCLUSIONS
  Increasing clinical evidence is clarifying appropriate first- and second-line treatments with targeted agents for patients with mRCC. Based on phase 2 and 3 trials, a sequential approach is most promising, while combination therapy is still investigational. The role of nephrectomy in mRCC is being evaluated in ongoing phase 3 clinical trials.
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicetre, France. jean-jacques.patard@live.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Geraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Tim
authors.initials: T
authors.lastname: Eisen
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.forename: Cora
authors.initials: C
authors.lastname: Sternberg
authors.forename: Brian
authors.initials: B
authors.lastname: Rini
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Toni
authors.initials: T
authors.lastname: Choueiri
authors.forename: Ronald
authors.initials: R
authors.lastname: Bukowski
authors.forename: Robert
authors.initials: R
authors.lastname: Motzer
authors.forename: Ziya
authors.initials: Z
authors.lastname: Kirkali
authors.forename: Peter
authors.initials: P
authors.lastname: Mulders
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D059146:Metastasectomy; D009392:Nephrectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D018579:Patient Selection; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors