Targeted therapies in the management of renal cell carcinoma: role of bevacizumab

Abstract

Bevacizumab (10 mg/kg every 2 weeks), in combination with interferon alpha-2a (IFN), is an effective option for first-line therapy for advanced and/or metastatic renal cell carcinoma (RCC). Two phase III trials clearly show significant improvements in progression-free survival and response rate in patients with treatment-naïve metastatic RCC receiving bevacizumab combined with IFN compared with IFN. The dose of IFN, which was initiated at 9 MIU 3 times a week in these trials, can be reduced to effectively manage IFN-related side effects without compromising the efficacy of bevacizumab plus IFN. Bevacizumab has good tolerability with manageable side effects, both alone and in combination with other agents; the tolerability profile of bevacizumab in combination with IFN is consistent with the well-characterized and well-established profiles of these therapies. The tolerability of bevacizumab combined with IFN and the flexibility to manage IFN-related side effects are important considerations when selecting first-line therapy. With a number of options now available for RCC therapy, optimizing their use is a key consideration in improving patient benefit.

Keywords: bevacizumab (Avastin®); efficacy; interferon alpha; low-dose interferon; renal cell carcinoma (RCC); tolerability.

Figure 1

Clear cell RCC represents the majority of all RCC tumors. Abbreviation: RCC, renal cell carcinoma.

Figure 2

Lowering the dose of IFN improves tolerability. Abbreviation: IFN, interferon alpha-2a.

Figure 3

Bevacizumab plus lower-dose IFN has a similar PFS to the total study population receiving bevacizumab plus IFN. Abbreviations: PFS, progression-free survival; IFN, interferon alpha-2a.

Figure 4

Bevacizumab is a good partner for combination therapy. Abbreviations: NK, not known; IFN, interferon alpha-2a.