Sorafenib is the first targeted agent to treat metastatic kidney cancer

Sorafenib is the first registered new-generation targeted drug for the treatment of metastatic renal cell carcinoma (RCC). As of today, there have been as many as 7 medications used for targeted therapy for disseminated RCC. This has provided a possibility to choose a drug and raised a number questions also remaining relevant at this moment: Which drug treatment should be started? Which criterion should be used to evaluate the efficiency of treatment? Is there any optimal sequence of drugs?

The given review attempts to systemize the currently available data to answer the asked questions.
According to the results of recently completed trials, sorafenib ranks below other agents for first-line therapy for metastatic RCC in progression- free survival (PFS), which fails to translate into overall survival (OS) rates. In contrast, due to its properties, the multikinase inhibitor sorafenib ensures better OS rates, by achieving disease control in the larger proportion of cases (the number of objective replies + stabilization), and has an admissible toxicity profile; at the same time the probability of treatment discontinuation because of intolerability of the drug is not greater than 10 %. Thus, by taking into account of the possible sequence of targeted drugs, one should try to achieve the highest OS sooner than to use PFS as an efficiency criterion. The clinical findings have served as the basis for including sorafenib as an agent for first- and next-line therapy for RCC in the leading Russian (RUSSCO, Russian Society of Oncologists) and foreign (ESMO, NCCN) clinical guidelines.