New treatment options for metastatic renal cell carcinoma

During the last decade, the treatment of advanced or metastatic renal cell carcinoma (RCC) was revolutionised with the advent of antiangiogenic drugs and tyrosine-kinase inhibitors. Several agents targeting the vascular endothelial growth factor (VEGF) pathway (sunitinib, bevacizumab, pazopanib, axitinib) or the mammalian target of rapamycin pathway (temsirolimus, everolimus) were since then progressively approved for first-line or later-line use in the treatment of patients with advanced RCC and became the new standard of care. As a result, the survival of patients with advanced RCC has significantly improved from a median overall survival of approximately 12 months in the cytokines era to more than 26 months with first-line VEGF inhibitors. During the two last years, the treatment of advanced RCC has witnessed a second revolution with the advent of immune checkpoint inhibitors, especially agents targeting the programmed cell death-1 receptor, as well as with the advent of new generation tyrosine-kinase receptor inhibitors. This article will review the new therapeutic options available for the treatment of advanced RCC, as well as the future potential molecular targets that are currently being investigated.