Renal-Cell Cancer — Targeting an Immune Checkpoint or Multiple Kinases

Abstract

Therapy for advanced renal-cell cancer has evolved considerably in the past decade, with new agents greeted like “buried treasure,” although these agents come with substantial costs to both patients and the health system. Before 2005, the widely used systemic agents were cytokines — interferon alfa and interleukin-2, which yielded modest efficacy and substantial toxicity. Nevertheless, underlining the immunogenic nature of renal-cell cancer, durable complete responses occur in some patients who receive interleukin-2; these patients are mostly cured.¹ After 2005, angiogenesis and mammalian target of rapamycin (mTOR) pathway inhibitors displaced cytokine therapy.^2,3 Although the most effective sequence of therapies is . . .