How is metastatic RCC treated
What are the two classes of medications used to treat metastatic RCC?
The two broad classes of agents used to treat metastatic RCC include (1) immunotherapy and (2) targeted therapy.
Immunotherapy may be divided into the more classical cytokine-based treatments such as interferon-α (IFN-α) and high-dose interleukin-2 (IL-2), and novel checkpoint inhibitors such as nivolumab. Nivolumab inhibits programmed death-1 (PD-1), which sits at the T-cell and antigen presenting cell interface and induces T-cell anergy. Targeted therapies include inhibitors of VEGF, including the monoclonal antibody bevacizumab and the small-molecule tyrosine kinase inhibitors such as sunitinib, pazopanib, sorafenib, and axitinib. Also U.S. Food and Drug Administration (FDA) approved are two inhibitors of the mammalian target of rapamycin (mTOR), namely everolimus and temsirolimus. Two multikinase inhibitors with affinity for a number of oncogenic drivers are lenvatinib and cabozantinib.
Beyond VEGF receptor, lenvatinib inhibits signaling through the fibroblast growth factor receptor (FGFR), while cabozantinib inhibits signaling through MET and AXL.
