[Molecular pathways of tumour angiogenesis and new targeted therapeutic approaches in renal cancer].

The conventional form of renal cell carcinoma (RCC) is a highly vascular tumour with an extremely poor prognosis in the presence of metastases. Significant progress has recently been made in the understanding of the molecular mechanisms leading to the vascular phenotype of renal cancer In particular, VHL disease constitutes a useful study model, as inactivation of the VHL gene leads to accumulation of HIF factor, inducing activation of genes such as: VEGF, PDGF, EPO, CaIX and TGF-alpha. The fact that VHL inactivation has been found in about 70% of sporadic renal cancers constitutes the best rationale to target the products of these genes. Candidate drugs currently target VEGF, VEGFR, PDGFR and tyrosine kinase receptors, which are necessary for intracellular signal transduction. The preliminary results of phase II trials in metastatic renal cancer, usually as second-line therapy, are very encouraging. The results of phase III trials will soon be available, but many studies are already evaluating these drugs either as first-line or in combination. Urologists have an opportunity to become familiar with these drugs by actively participating in trials of adjuvant therapy that will be initiated in the near future.