Current options in the management of advanced renal-cell carcinoma

Abstract

Approximately 30% of patients with renal-cell carcinoma (RCC) have metastases at diagnosis, and 40% of patients with initially localised disease develop dissemination. There is no consensus on the optimal management of advanced RCC and complication is due - at least in part - to different outcomes of patients classified based on prognostic category. Palliative surgical interventions - nephrectomy or/and resection of metastases may play a role in many clinical situations. Advanced RCC is resistant to cytotoxic and hormonal therapy, whereas the benefit of immunotherapy (interferon α or/and interleukin 2) is modest and cytokines may be helpful for a subgroup of patients with favourable prognosis (low risk). Based on the available evidence, the use of either sunitinib or bevacizumab with interferon α could be considered in the first-line treatment for patients with favourable and intermediate prognosis (low and intermediate risk). Temsirolimus is recommended for the initial treatment of patients with unfavourable prognosis (high risk). Current evidence indicates sorafenib in cytokine refractory disease. Everolimus is an active agent in patients with progression on multikinase inhibitors (sunitinib and/or sorafenib). The following expert opinions aim to interpret and integrate the data from prospective clinical trials. Opinions presented do not apply to all patients and each should be adapted individually.