Treatment Strategies in Metastatic Renal Cancer
In the past 15 yr there have been major advances in systemic anticancer therapy for metastatic clear-cell renal cell carcinoma (mRCC). Drug options, including combinations, are evolving rapidly, and include oral VEGFR inhibitors (tyrosine kinase inhibitors [TKIs] that can be highly VEGR-specific or have additional targets such as MET and FGFR, among others), mTOR inhibitors, and immunotherapy agents (normally given intravenously) that include PD-1, PD-L1, and CTLA-4 inhibitors and inhibitors for emerging targets such as HIF-2? and LAG-3 [ [1] ]. Although 5-yr survival for mRCC remains much lower than that for localised disease [ [2] ], outcomes are improving and the latest CheckMate 214 trial update reported that 5-yr survival was up to 48% [ [3] ]. A range of recommended first- and subsequent-line agents within these drug classes is now available either as monotherapy or in combinations. Treatment decisions depend on factors that include the patient’s prognostic International Metastatic RCC Database Consortium (IMDC) score (which takes into account time since diagnosis to start of systemic therapy, performance status, and a number of biochemical and haematological variables), comorbidities, age, and metastases sites.