Immunotherapy for the treatment of renal cancer has been available since 1984, but it is a non-specific and very toxic treatment for advanced renal cancer. Since 2004, a number of new biological therapies offering targeted treatment for advanced renal cancer have been developed; sunitinib (Sutent®) and sorafenib (Nexavar®) were launched in 2004, and by the year 2014, bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus (Afinitor ®), pazopanib (Votrient®), and axitinib (Inlyta®) all have marketing authorisation for the treatment of advanced RCC while cabozantinib (cabometyx) and Tivozanib (Fotiva) were made available for firstline TKI. However, even with these new advances in drug development, there remain a number of challenges for the doctors treating patients with renal cell carcinoma (RCC):
- Which is the best first-line therapy?
- Can treatment be individualised, as is the case for breast cancer?
- What is the role of nephrectomy, especially in patients with metastatic disease?
- Which is the best second- and third-line treatment?
Cancer researchers are investigating targeted treatments and immunotherapies for advanced RCC, in addition to various combinations of drugs and sequencing of drugs to find the most effective and safest treatment for patients with late stage disease. Research into individualised treatments for RCC patients is on going.
In 2020 NICE approved the use of Entrectinib and Larotrectinib which are genomic biomarker based treatments which are available through the cancer drugs fund for treating ntrk fusion-positive solid tumours.[1]
Please see Module 8 for more information about the advances in systemic RCC treatments.