Table 7.

Summary of evidence-based approach to therapy for advanced or recurrent renal clear cell carcinoma in 2009 (Adapted from Rini B, American Society for Clinical Oncology Annual Meeting 2008 [Rini, 2008b]).

Setting	Patients	Therapy (level 1)	Other options (≥ level 2)
Untreated	Good or intermediate  MSK risk	Sunitinib [Motzer et al. 2007b]  Bevacizumab + IFN [Rini et al. 2008;  Escudier et al. 2007c]  Clinical trial	HD IL-2 [Fisher et al. 2000]  Sorafenib [Ratain et al. 2006]  Clinical trial observation
Untreated	Poor MSK risk	Temsirolimus [Hudes et al. 2007a]  Clinical trial	Sunitinib [Motzer et al. 2007a]  Clinical trial
Refractory	Cytokine	Sorafenib [Escudier et al. 2007a] Pazopanib [Hutson et al. 2007b]  Clinical trial	Sunitinib [Motzer et al. 2006],  Bevacizumab [Bukowski et al. 2007b]
Refractory	VEGF; mTOR	Everolimus[Motzer et al. 2008b]  Clinical trial	Other VEGF TKIs  Axitinib [Dutcher et al. 2008;  Rixe et al. 2007]

IFN, interferon; MSK, Memorial Sloan Kettering; mTOR, mammalian target of rapamycin; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor.