Targeted therapy for renal cell carcinoma: a new treatment paradigm - PubMed (original) (raw)

Targeted therapy for renal cell carcinoma: a new treatment paradigm

Thomas E Hutson. Proc (Bayl Univ Med Cent). 2007 Jul.

Abstract

Metastatic clear cell renal cell cancer has traditionally been treated with cytokines (interferon or interleukin-2). Improved understanding of biology has engendered novel targeted therapeutic agents that have altered the natural history of this disease. The vascular endothelial growth factor and its related receptor and the mTOR signal transduction pathway have particularly been exploited. Sunitinib malate, sorafenib tosylate, temsirolimus, and bevacizumab have improved clinical outcomes in randomized trials. Other multitargeted tyrosine kinase inhibitors (lapatinib, axitinib, pazopanib) and antiangiogenic agents (VEGF Trap, lenalidomide) have also demonstrated activity in early studies. Combinations of these agents are being evaluated. The future of the therapy of renal cancer appears promising owing to the efficacy of these novel agents.

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Figures

Figure

Figure

Consequences of mutation or inactivation of the von Hippel Lindau (VHL) gene. VHL normally encodes a protein (p-VHL) that targets hypoxia-inducible factor (HIF) for proteolysis. As a result of VHL inactivation, a defective p-VHL is produced and HIF is up-regulated, translocates to the nucleus, and results in the transcription of several genes involved in angiogenesis and tumor growth. These genes include vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), transforming growth factor (TGF)-α, basic fibroblast growth factor (bFGF), carbonic anhydrase IX (CA IX) or G250, erythropoietin (EPO), and others. OH indicates hydroxyl group; Ub, ubiquitin; Glut-1, glucose transporter 1; PAI-1, plasminogen activator inhibitor 1. Adapted from Kim WY. J Clin Oncol 2004;22:4991–5004.

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