Drugs for the treatment of advanced/metastatic renal cancer: Current perspectives
Renal cancer comprises 2% of all cancer, with 210,000 new cases being reported every year worldwide, and in the last 20 years it has shown an increase of 30%. During the last 5 years, significant progress has been made in the therapeutic approach to advanced/metastatic renal cancer. The drugs involved in the treatment of advanced/metastatic renal cancer are classified according to their molecular action. The most significant categories are the tyrosine kinase inhibitors (sorafenib, sunitinib), cytokines (IFN-α, IL-2), mTOR inhibitors (temsirolimus, everolimus) and VEGF inhibitors (pazopanib, axitinib, bevacizumab). Sunitinib, prescribed as a first line treatment, has doubled the median progression free survival compared with IFN-α, and has decreased the risk of death or progression of the disease. Sorafenib has achieved longer overall improvement in both progression free survival and in symptom worsening compared with placebo. Bevacizumab, when co-administered with IFN-α, has doubled progression free survival and significantly increased the response of the tumor to treatment, compared with monotherapy with IFN-α. mTOR inhibitors are indicated in patients with poor prognosis and those resistant to the first line targeted therapeutic approach. Other drugs used in renal cancer have shown promising results without producing significant or prohibitive side effects, but comparative trials are needed in order to establish their superiority over the standard first line regimes. The side effects of all the drugs studied are not specific and are those commonly seen in clinical medicine. Physicians should be aware of the possible side effects, in order to attribute them to the drugs and not to an underlying disease. © Athens Medical Society.
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