Emerging agents in renal cell carcinoma

The landscape of therapy for metastatic renal cell carcinoma (mRCC) has changed drastically over the past decade, hinging largely on the approval of six targeted agents. While this undoubtedly represents a milestone in the treatment of this disease, it is critical to bear in mind that the six agents fall broadly within two mechanistic categories: (1) vascular endothelial growth factor (VEGF)-directed therapies (sunitinib, sorafenib, pazopanib, and bevacizumab), and (2) inhibitors of the mammalian target of rapamycin (mTOR, everolimus, and temsirolimus). Other chapters in this book will delineate agents that are consistent with this paradigm, including novel VEGF-directed therapies such as axitinib and tivozanib. Ultimately, however, the research community will need to look toward agents that target distinct signaling axes, or employ novel mechanisms to augment antitumor immunity. The current chapter explores a range of emerging therapies – ranging from vaccine therapy to cytotoxic chemotherapy – that may add to the current armamentarium for mRCC.