Sorafenib in the Management of Metastatic Renal Cell Carcinoma

Purpose: Sorafenib represents one of the two standards of care for patients with metastatic renal cell carcinoma (mRCC). In the present review, we provide information regarding the use of sorafenib in first and second lines. We also describe results for dose escalation strategies. Finally, we provide data addressing the efficacy of sorafenib in patients with mRCC of non-clear-cell histology. Recent Findings: Sorafenib is a valid first-line agent. Sorafenib response rates and toxicity are not affected by patient age or site of metastasis. The sequence of first-line sorafenib followed by second-line sunitinib resulted in a longer duration of response than did the opposite sequence. Sorafenib efficacy in first-line therapy can be potentiated by co-administration of low-dose interferon. Moreover, in first-line therapy, impressive response rates were recorded when the dose of sorafenib was escalated beyond the standard 400 mg twice daily. Similarly impressive response rates were observed with dose escalation in second-line therapy. It is notable that dose escalation after failure of standard sorafenib dose also prolongs progression-free survival. Finally, the efficacy of sorafenib is not limited to clear-cell histology, but also applies to chromophobe and papillary mRCC variants. Summary: Sorafenib is a highly effective and well-tolerated agent for first- and second-line patients with clear-cell, chromophobe, or papillary mRCC variants.