Renal cell cancer has been refractory to
drug therapy in the large majority of patients. Targeted agents including
sunitinib have been intensively evaluated in
renal cell cancer over the past 5 years.
Sunitinib is an oral small molecule inhibitor of several targets including multiple
tyrosine kinase receptors of the angiogenesis pathway. This review surveys the rationale, development, validation, and clinical use of
sunitinib that received conditional approval for use in North America and Europe in 2006. In patients with the clear-cell subtype of
renal cell cancer and metastatic disease with good or moderate prognostic factors for survival,
sunitinib 50 mg for 4 weeks of a 6-week cycle provides superior surrogate and patient-reported outcomes when compared with
interferon-alfa, the previous commonly used first-line drug. Overall survival has not yet shown improvement over
interferon and is problematic because of patient crossover from the control arm to
sunitinib at
disease progression. Toxicity is significant but manageable with experienced monitoring.
Sunitinib therapy is an important step forward for this condition. High cost and limited efficacy support the ongoing search for further improved
therapy.