Renal and urological problems: Edited by Fred SaadCurrent systemic management of metastatic renal cell carcinoma – first line and second line therapyWright, Ian; Kapoor, Anil Author Information Genito Urinary Oncology Program, Juravinski Cancer Centre, G344-St. Joseph's Hospital, Hamilton, Ontario, Canada Correspondence to Dr Anil Kapoor, MD, FRCSC, Chair, Genito Urinary Oncology Program, Juravinski Cancer Centre, G344-St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada E-mail: [email protected] Current Opinion in Supportive and Palliative Care: September 2011 - Volume 5 - Issue 3 - p 211-221 doi: 10.1097/SPC.0b013e3283490418 Buy Metrics Abstract Purpose of review The improved understanding of the complex biochemical and genetic pathways associated with renal-cell carcinoma (RCC) has led to rapid development of novel targeted therapies over the last decade. The aim of this review is to present and discuss the most recent clinical trial data that support the currently approved first and second line agents in the treatment of metastatic renal cell carcinoma (mRCC). New directions in treatment will also be explored. Recent findings The currently approved first and second line agents for the treatment of mRCC include sunitinib, pazopanib, sorafenib, bevacizumab, temsirolimus, and everolimus. Each of these new agents has shown meaningful clinical benefit in phase III trials and as a group they have replaced cytokines as the frontline therapy for advanced and mRCC. Several new agents are currently being evaluated in phase II and III studies that may provide further benefit in the future. Summary The treatment paradigm for mRCC had drastically changed over the last decade bringing new hope for improved outcomes and ongoing advances. In spite of recent headway, mRCC remains a disease with no curative therapy and more effective treatment options are needed. Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.