Is advanced renal cell carcinoma becoming a chronic disease

1reported the effi cacy of the multitargeted receptor tyrosine kinase inhibitor pazopanib for the treatment of metastatic renal cell carcinoma (RCC). This report is the latest in a series that, since 2007, has led to the licensing of six drugs to treat this disease (pazopanib, sunitinib, sorafenib, temsirolimus, everolimus, and bevacizumab). 1–7 These agents inhibit signalling in either the vascular endothelial growth factor (VEGF) or mammalian target of rapamycin (mTOR) pathways. 8 The choice of drugs is potentially bewildering but there is no doubt that these targeted agents have altered the natural history of what was for 80% of patients an untreatable disease. 2,4,6,7 The therapeutic revolution that targeted agents have brought about in metastatic RCC has changed drug-development strategies in this disease because of two observations: targeted agents are non-curative and non-cross-resistance between drugs with very similar targets can occur, although eventually drug resistance ensues. 9 There are three major issues that