Since 2005, when sorafenib was approved for the treatment of metastatic renal cell carcinoma, the treatment of metastatic renal cell carcinoma has entered the era of targeted therapy. To date, the U.S. Food and Drug Administration has approved more than ten drugs and regimens for the treatment of metastatic renal cell carcinoma. These drugs are divided into the following categories in terms of mechanism of action.
(1) Anti-vascular endothelial growth factor/vascular endothelial growth factor receptor (VEGF/VEGFR) pathway, mainly including sunitinib, pegaptanib, sorafenib, axitinib, cabozantinib, lenbuterol, and sorafenib. (ii) mammalian target of rapamycin (mTOR) pathway: including everolimus and tesilomus; (iii) immune checkpoint inhibitors: including nabritumomab, pabrolizumab and epirimumab; (iv) others: including cytokines [interleukin-2 and interferon-α (IFN-α)] and chemotherapy (gemcitabine and doxorubicin). Chemotherapy is mainly used as a treatment for patients with metastatic renal cell carcinoma with sarcomatoid differentiation.
Combination regimens include pablizumab in combination with axitinib, pablizumab in combination with lenvatinib, nabritumomab in combination with cabozantinib, nabritumomab in combination with ibritumomab (for intermediate-to-high risk advanced clear cell predominant renal cell carcinoma), avelumab in combination with axitinib, lenvatinib in combination with everolimus (for second-line treatment of advanced clear cell predominant renal cell carcinoma) ), bevacizumab + erlotinib (for some patients with progressive papillary renal cell carcinoma, including hereditary smooth muscle disease and renal cell carcinoma), bevacizumab + everolimus (for some patients with progressive papillary renal cell carcinoma, including hereditary smooth muscle disease and renal cell carcinoma), etc.
Currently, drugs approved for the treatment of advanced renal cell carcinoma in China include pegaptanib, sunitinib, axitinib, sorafenib, everolimus, interleukin-2, and IFN-α.
Bisphosphonates or RANK ligand inhibitors are recommended for patients with bone metastases and creatinine clearance ≥30 ml/min.