Targeted Therapy For Renal Cell Cancer
Renal cell cancer was never responsive to chemotherapy and the survival rate for metastatic disease was very low in the 90’s – interleukin-2 had few long-term survival patients but the overall response rate was less than 10% and the toxicity was very high.
Over the last two decades numerous targeted therapies were developed with a better understanding of the molecular and genetic alterations present in renal cell cancer.
Sorafenib was the first tyrosine kinase inhibitor FDA approved for metastatic renal cell cancer. Sorafenib blocks angiogenesis and cell growth. Sorafenib is a pill taken twice a day. The most common side effects are rash, diarrhea, and hand-foot syndrome.
Sunitinib is also in pill form and is a tyrosine kinase inhibitor with side effects similar to sorafenib. Temsirolimus blocks a protein called M-tor, which stimulates cell growth. It is administered intravenously on a weekly basis. The most common side effects are fluid retention, rash, mouth sores.
Everolimus is also an M-tor inhibitor but its administration is oral and has similar side effects as temsirolimus.
Bevacizumab is an anti-angiogenic. It is given intravenously, and the most common side effects are increase in blood pressure, bleeding, intestinal perforation, heart problems and slows wound healing.
Pazopanib is a tyrosine kinase inhibitor and anti-angiogenic. It is given in pill form. The liver function test needs to be monitored and the heart needs to be monitored with EKG’s.
Axitinib is a pill taken twice a day. It is a tyrosine kinase inhibitor as well, and shares the same side effects as nexavar and sunitinib. Cabozantinib is one of the newest FDA approved tyrosine kinase inhibitors. It is a pill taken once a day and it is also anti-angiogenic. It can cause bleeding and intestinal perforation.
Lenvatinib is also a tyrosine kinase inhibitor as well as anti-angiogenic.
With the new drugs currently available for metastatic renal cell, toxicity has decreased, and survival has significantly improved.