Changing landscapes in the treatment of advanced renal cell carcinoma

Abstract

Historically, advanced renal cell cancer stood as a devastating diagnosis due to paucity of systemic therapy options.  Cytokine therapy including high dose IL2 and interferon alpha comprised the mainstay of advanced renal cell cancer treatment with modest benefit.  With better understanding of the biology of the Von Hippel Lindau axis in the past 2 decades, antiangiogenic therapeutics came on the scene starting late 2005 with currently 7 targeted agents approved by the FDA for the treatment of advanced renal cell cancer.  Further, currently in development are check point inhibitors – a form of “targeted immunotherapy” – which have shown significant clinical efficacy in the management of this disease, marking a resurgence of immunotherapy in a more sophisticated fashion.  In this review, the historical perspective, current treatment options and guilelines available and what is on the horizon in the treatment of renal cell cancer will be discussed.  With advances in our understanding of this disease, treatment armamentarium has remarkably increased, thereby improving overall prognosis of patients affected with this disease.