Treatment of metastatic renal cell carcinoma.

The median survival of patients with metastatic renal cell carcinoma (mRCC) has increased from 10 months to more than 40 months since the advent of targeted therapy. Sunitinib and bevacizumab represent the first-line standards of care for patients with clear cell mRCC. Temsirolimus is the standard of care for those with poor-risk features. Additionally, exploratory analyses of the temsirolimus data indicate important benefits for those with non-clear-cell mRCC. Everolimus has proved its efficacy in second-line therapy. Sunitinib and sorafenib are also effective for non-clear-cell histological subtypes and after failure of first-line treatment. Potential survival benefits can also be derived from cytoreductive nephrectomy (CNT) in patients previously exposed to sunitinib or bevacizumab. Phase III studies are ongoing to address the importance of CNT in the targeted therapy era. Such information is crucial to ensure timely delivery of a combination of medical and surgical therapies to this patient population.