OPTIMIZATION OF SECOND-LINE TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA CANCER AFTER USE OF VEGF RECEPTOR – TYROSINE KINASE INHIBITORS (LITERATURE REVIEW)

Sequential targeted therapy is now the standard of treatment for metastatic renal cell carcinoma (mRCC). A switch into a different mechanism of action of mTOR inhibitor after vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKI) in second-line therapy helps to elude cumulative toxicity and cross-resistance, which may occur in the sequential use of different anti-VEGFR agents through the overlapping mechanisms of action. After VEGFR TKI therapy failure, treatment with the mTOR inhibitor everolimus in second-line therapy is recognized to be effective and safe, substantially increasing progression-free survival, without worsening its quality. Everolimus is recommended as second-line targeted treatment for patients with progressive mRCC after primary VEGFR TKI use. Switching to everolimus is warranted especially in patients who have a poor response to or a high toxicity of first-line antiangiogenic therapy.