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.