Metastatic kidney cancer: Choice of first-line therapy

The current practice in prescribing targeted agents for patients with metastatic kidney cancer (KC) is based on the results of a few large-scale multicenter randomized trials of the efficacy of different drugs in different clinical situations. Most international and national oncology and urology associations recommend 3 standard treatment options: 1) bevaсizumab in combination with interferon; 2) sunitinib; 3) pazopanib as first-line therapy in patients with good and intermediate risk metastatic KC. The valid choice of a drug for first-line therapy is one of the topical problems of real clinical practice. The criteria for choosing a drug are primarily its efficacy and toxicity profile. In addition, the specific features of a patient’s health status, the presence of different intercurrent diseases, lifestyle, and professional peculiarities also affect the choice of a treatment regimen. The paper comparatively reviews the efficacy and toxicity of bevaсizumab in combination with interferon at different doses, those of sunitinib and pazopanib, on the basis of which the choice of a drug for the therapy of patients with good and intermediate risk metastatic KC may be planned in a specific clinical situation.