New drug therapies for advanced renal cell carcinoma.

The incidence of renal cell cancer is increasing and surgery is the only curative treatment for patients presenting with localized disease at diagnosis. The treatment of metastatic renal cell cancer is palliative and, until recently, immunotherapy has been the standard treatment approach with response rates between 10 and 20%. An increase in the appreciation of the biology of this disease has resulted in a number of new 'targeted' therapies being developed. Most notable is the introduction of tyrosine kinase inhibitors with significant activity in both treatment-naive and cytokine-refractory renal cell cancer. Drugs targeting angiogenic pathways also appear promising. These agents are being rapidly introduced into clinical practice, but further studies are needed to establish their optimal place in the management of renal cell cancer and, in particular, the role of combination and/or sequential therapy.