Investigational Approaches in RCC

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There is limited utility for an mTOR inhibitor in the frontline setting for patients with renal cell carcinoma (RCC), notes Sumanta Kumar Pal, MD. The phase II RECORD-3 study compared sunitinib followed by everolimus to sequential everolimus and sunitinib. Overall, the trial did not demonstrate that first-line everolimus was noninferior to first-line sunitinib.

In the high-risk population, an mTOR inhibitor could be effective, notes Pal. In this situation, he prefers to utilize temsirolimus versus everolimus. At this time, there remains a need for prospective clinical trial data assessing the efficacy of an mTOR inhibitor in the frontline setting for high-risk patients with RCC.

In addition to frontline mTOR inhibition, there is limited data on the efficacy of neoadjuvant and adjuvant treatment for RCC. Neoadjuvant therapy would ideally be used when there is potential for curing disease prior to its surgical removal, notes Saby George, MD. However, this approach remains largely theoretical. Future trials should focus on tumor shrinkage or the use of nephron-sparing approaches in the setting of neoadjuvant therapy, George suggests.