Continued Progress in the Treatment of Advanced Renal Cell Carcinoma: An Update on the Role of Sunitinib

ContextRenal cell carcinoma (RCC) constitutes approximately 2–3% of all cancers worldwide. Approximately a third of patients diagnosed with RCC present with metastatic disease (mRCC) and in about a third of patients with localized disease, RCC recurs following treatment. Metastatic renal cell carcinoma (mRCC) is associated with poor survival rates, and until recently, cytokines were the only treatment options for mRCC.ObjectiveThe rationale for the use of targeted agents in mRCC is reviewed, and the key challenges to optimizing treatment are discussed.Evidence acquisitionClinical data on the safety and efficacy of targeted agents in mRCC, practical therapy management, and patient stratification strategies are reviewed.Evidence synthesisThe development of targeted agents, including sunitinib, sorafenib, temsirolimus, and bevacizumab (given with interferon-α [IFN-α]) has dramatically changed the outlook for patients with mRCC and improved survival rates. Sunitinib has demonstrated clinical efficacy for mRCC in phase 2 and phase 3 trials and in an expanded-access study. Sunitinib is now a reference standard of care for the first-line treatment of patients with mRCC.As with the other targeted agents, sunitinib treatment is associated with a particular profile of adverse events (AE). Management of AEs is critical, as tolerability can affect adherence to therapy and limit clinical benefit. The development of practical strategies to support the optimal use of targeted agents is essential.In addition, prognostic factors such as tumor histology affect treatment outcome. Patient stratification into risk groups based on prognostic factors allows optimal treatment selection. A treatment algorithm, based on patient stratification and the available clinical data for the targeted agents, may facilitate the optimal choice of treatment for patients with mRCC.ConclusionsThis supplement reviews the clinical data from sunitinib studies in mRCC as well as practical therapy-management strategies and presents a treatment algorithm for mRCC. Finally, experience from the clinic is presented.