In randomized controlled studies, sorafenib and sunitinib agents have demonstrated an increased response rate, reduced toxicity, and improved survival compared with interferon alfa in patients with renal cell carcinoma.5,6 This patient is not a candidate for high-dose interleukin 2 due to his cardiac and renal dysfunction. Metastasectomy or ablation of metastases may be considered in the future if the patient achieves a good response to systemic therapy. Observation is a less desirable option in this patient, since there has been objective evidence of disease progression over the past 6 months.
- Sorafenib or sunitinib.
5. Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. TARGET Study Group. N Engl J Med 2007;356:125-34.
6. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007;356:115-24.
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