[Renal cell carcinoma-response criteria of molecular targeted therapy and the timing of sequential drugs in patients with advanced renal cell carcinoma].

With the introduction of molecular targeted drugs, the treatment of metastatic renal cell carcinoma has dramatically changed. There are now four approved targeted therapies that work against the vascular endothelial growth factor and the mammalian target of rapamycin pathways. However, a complete response is rarely observed, and a change of drugs is usually needed. On progression after immunotherapy, sorafenib has demonstrated a progression-free survival(PFS)benefit. After the failure of initial vascular endothelial growth factor(VEGF)therapy, everolimus has shown a PFS benefit in clinical trials. Although drugs are changed during disease progression according to the response evaluation criteria in solid tumors(RECIST)criteria in clinical studies, the choice of targeted therapy and the timing of the start of sequential drugs are usually based on physician preference, reimbursement issues, and the toxicity profile. I usually decide when to start sequential therapy based on the growth speed of targeted lesions and metastatic organs. In patients who have a solitary brain metastasis or bone metastases as new lesions, local treatment of the lesions would also be one of the treatment options. Further studies are warranted to establish a criteria for the changing of drugs after disease progression.