Join Steven Chang, MD and Toni Choueiri, MD as they present their multidisciplinary expertise on a range of cases pertaining to kidney cancer.

To date, seven such agents have been approved by the FDA for the first- and second-line treatment of advanced RCC: sunitinib malate, sorafenib tosylate, temsirolimus, everolimus, bevacizumab in combination with interferon, pazopanib, and axitinib. This has led to a paradigm shift of treatment of kidney cancer from cytokine immunotherapy to targeted therapy and has significantly improved patient survival rates.
Prior to therapy selection, the patients are stratified in risks groups.  The most widely used prognostic factor model is from the Memorial Sloan-Kettering Cancer Center (MSKCC). However, the MSKCC prognostic risk profiles are derived from the era of immunotherapy and limited to a population of patients eligible for participation in immunotherapy clinical trials. A new prognostic model for patients with advanced RCC treated with VEGF-targeted therapy has recently been developed and validated known as the International Metastatic RCC Database Consortium or Heng’s model.

All patients with advanced RCC require best supportive care and advances have been in this area as well. Strategies have been developed to enhance tolerability of the targeted agents including dose reductions, schedule changes or alternative therapies. Progression/relapse and the need for subsequent lines therapy in patients with RCC are nearly universal. Sequencing the appropriate therapy for maximum benefit is critical.

Despite the advances, the newer therapies have not yielded a long-term solution for patients. The American Cancer Society estimates over 63,920 Americans will be diagnosed with kidney cancer in 2014 and over 13,860 will die of the disease. Majority of patients are diagnosed with locally advanced or metastatic disease.  The 5-year survival rate is still dismal, in the order of 10%. New drugs with novel mechanism of action (e.g., denosumab) are available for treatment of metastatic bone disease. New agents are currently being studied as adjuvant, first- and subsequent line therapy options  including the use of the currently approved targeted therapy in the adjuvant setting.