New perspectives in the treatment of metastatic renal cell carcinoma

Since 2007, the advent of so-called “targeted” therapy has revolutionized the management of renal cell carcinoma (RCC), replacing interferon or interleukin-2 immunotherapy. The present article first reviews the fundamentals of current practice in the management of metastatic-phase RCC. It then goes on to consider the new perspectives opening up in terms of treatment strategy (sequential or combined treatments and new drugs) in what can be seen as a second phase in this ongoing revolution in treatment. In the years to come, the challenge will be to learn to optimize the use of the many drugs available, possibly in association with micro-invasive techniques, so as to achieve the third phase of the revolution: long-term remission in metastatic RCC. The search for factors predictive of response and greater knowledge of tumor biology will be essential steps, yet to be made, toward this goal.