Managing Untreated Metastatic Renal Cell Carcinoma

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There are currently seven targeted therapies approved by the FDA as treatments for patients with metastatic renal cell carcinoma (RCC). These agents can be classified into two main mechanistic categories: VEGF inhibitors and mTOR inhibitors. In addition to these targeted approaches, immunotherapy has played a role in RCC in the form of interleuken-2 and recently the PD-1 inhibitors, although these are not yet approved.

Participation in clinical trials often expands beyond the approved types of agents to novel approaches, including PD-1 and MET inhibitors, explains Sumanta Kumar Pal, MD. The toxicity associated with these investigational agents may be more acceptable than current options, Pal suggests. With this in mind, participation in a clinical trial may serve to maximize a patient’s quality of life.

First-line treatment choices for an individual with previously untreated, metastatic RCC with a good/intermediate prognosis include bevacizumab in combination with interferon or a tyrosine kinase inhibitor (TKI), such as sunitinib or pazopanib, suggests Saby George, MD. In many cases, the bevacizumab combination is not as frequently utilized as TKI therapies, as the combination regimen requires multiple visits to a clinic for infusions, states George.