A better understanding of the molecular biology of renal cell carcinoma (RCC) has led to a dramatic paradigm shift in the treatment of patients with metastatic disease. Historically, a nonspecific immune approach using cytokines was employed, but recently this has transitioned to a molecularly‐targeted approach against vascular endothelial growth factor (VEGF) and related pathways. Several anti‐VEGF agents, including ligand‐binding agents such as bevacizumab and the small molecule inhibitors of VEGF and related receptors such as sunitinib and sorafenib, have demonstrated clinical activity in patients with metastatic RCC. Other agents that inhibit alternative targets such as the mammalian target of rapamycin (mTOR) have also demonstrated activity. This generation of novel molecular targeted therapies continues to show great promise. The purpose of this review is to summarize the current management and to discuss potential future directions in the management of metastatic RCC.

中文翻译：

---

晚期肾细胞癌的治疗新进展

对肾细胞癌 (RCC) 分子生物学的更好理解已经导致转移性疾病患者治疗的范式转变。从历史上看，使用细胞因子的非特异性免疫方法已被采用，但最近已转变为针对血管内皮生长因子 (VEGF) 和相关途径的分子靶向方法。几种抗 VEGF 药物，包括配体结合剂（如贝伐单抗）和 VEGF 的小分子抑制剂以及相关受体（如舒尼替尼和索拉非尼），已在转移性 RCC 患者中显示出临床活性。其他抑制替代靶标的药物，例如哺乳动物雷帕霉素靶标 (mTOR)，也已证明具有活性。这一代新型分子靶向疗法继续显示出巨大的希望。