Table 1. Current algorithm for management of advanced RCC.

Setting	Patients	Primary therapy	Other options
First line	Good or intermediate riska	Sunitinib Bevacizumab+IFN Pazopanib	HD IL-2 Sorafenib Observation
	Poor riska	Temsirolimus	Sunitinib Pazopanib
Second line	Post cytokine	Sorafenib Pazopanib Axitinib	Sunitinib Bevacizumab Temsirolimus
	Post VEGF inhibitor	Everolimus Axitinib	Other VEGF inhibitors Temsirolimus
	Post mTOR inhibitor	Axitinib	Other VEGF inhibitors
Third line	Post TKI→TKI	Everolimus	Temsirolimus
	Post mTOR→TKI or Post TKI→mTOR	Different TKI	Rechallenge TKI

Abbreviations: HD=high dose; IFN=interferon; IL=interleukin; mTOR=mammalian target of rapamycin; TKI=tyrosine kinase inhibitor; VEGF=vascular endothelial growth factor.

^aBased on anaemia, hypercalcaemia, KPS<80%, time from diagnosis to treatment <1 year and high LDH (Motzer et al, 2002); prognostic factors identified in patients receiving first-line VEGF-targeting therapy were: anaemia, hypercalcaemia, KPS <80%, time from diagnosis to treatment <1 year, neutrophilia and thrombocytosis (Heng et al, 2009).