The data are expanding regarding the use of TKIs in RCC. But the two approved TKIs, sorafenib and sunitinib, may be used in various settings. Sunitinib has robust activity in the front-line setting and should be considered as a first-line standard of care in advanced RCC. Sorafenib prolongs refractory disease and cytokine failures, and is used as a second-line therapy. The utility of both of the agents is being investigated in the adjuvant setting, as well as the neoadjuvant setting of resectable and unresectable RCC.
Summary
Use of the newer medications is a promising strategy for managing metastatic RCC. At the same time, the dose-limiting AEs, which are the off-target effects of these agents, are a formidable challenge to manage. Well-managed toxicities promise effective long-term delivery and thus potentially longer PFS in patients who had limited hope in the not too distant past.
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