Medical Therapy for Advanced Kidney Cancer
patients had a PR according to Response Evaluation Criteria In Solid Tumors (RECIST). Interestingly, a considerable number of patients were treated with the primary tumour in situ. A phase III trial comparing tivozanib with sorafenib in patients with advanced RCC is ongoing (NCT01030783).48
Conclusion
Current level 1b evidence supports either sunitinib monotherapy or bevacizumab in combination with IFN-α as first-line treatment in patients with metastatic or unresectable clear-cell RCC and favourable or intermediate prognosis according to MSKCC criteria. Pazopanib is a new therapeutic option in the first-line setting and is currently being assessed in a phase III trial with sunitinib. In patients with poor prognostic features, according to modified MSKCC criteria, temsirolimus can be recommended as first-line treatment with level 1b evidence. Biological response modifiers, including IFN-α and high-dose IL-2, remain an option for the first-line treatment of selected patients with clear cell mRCC and good prognosis. Second-line treatment should be divided into treatment following previous biological response modifiers and following previous targeted therapies. Currently, sorafenib is recommended with level
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Axel Bex is a Urological Surgeon in the Department of Urology at the Netherlands Cancer Institute in Amsterdam. His clinical research focuses on the treatment of advanced stages of renal cell carcinoma (RCC), combining systemic therapy with surgery. He is principal investigator of the European Organisation for Research and Treatment of Cancer (EORTC) trial investigating immediate versus deferred cytoreductive nephrectomy in patients with metastatic RCC treated with sunitinib.
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