title: Current systemic management of metastatic renal cell carcinoma - first line and second line therapy.
abstract: OBJECTIVE
  The improved understanding of the complex biochemical and genetic pathways associated with renal-cell carcinoma (RCC) has led to rapid development of novel targeted therapies over the last decade. The aim of this review is to present and discuss the most recent clinical trial data that support the currently approved first and second line agents in the treatment of metastatic renal cell carcinoma (mRCC). New directions in treatment will also be explored.
  
  
  RESULTS
  The currently approved first and second line agents for the treatment of mRCC include sunitinib, pazopanib, sorafenib, bevacizumab, temsirolimus, and everolimus. Each of these new agents has shown meaningful clinical benefit in phase III trials and as a group they have replaced cytokines as the frontline therapy for advanced and mRCC. Several new agents are currently being evaluated in phase II and III studies that may provide further benefit in the future.
  
  
  CONCLUSIONS
  The treatment paradigm for mRCC had drastically changed over the last decade bringing new hope for improved outcomes and ongoing advances. In spite of recent headway, mRCC remains a disease with no curative therapy and more effective treatment options are needed.
authors: Genito Urinary Oncology Program, Juravinski Cancer Centre, G344-St. Joseph's Hospital, Hamilton, Ontario, Canada.
authors: Ian
authors: I
authors: Wright
authors: Anil
authors: A
authors: Kapoor
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016898:Interferon-alpha