Bone is a common site of metastatic spread in patients with advanced
renal cell carcinoma (RCC) occurring in around one-third of patients enrolled in clinical trials evaluating modern systemic
therapies for this disease. Until recently, limited systemic therapeutic options were available for advanced RCC. Nowadays, a quiver of agents have demonstrated activity, including compounds targeting the
vascular endothelial growth factor (
VEGF) axis and those targeting the
mammalian target of rapamycin (mTOR). Despite a detailed biological understanding of how these drugs work, their effect on bony
metastases is less clear. Data suggesting that
bisphosphonates (namely
zoledronic acid) benefit patients with bone
metastases from advanced RCC was gathered prior to the targeted
therapy era; therefore, there is some uncertainty about their role in patients on modern RCC
therapies. This review summarizes the current targeted
therapies registered for use in advanced RCC and postulates how some of them might affect the behavior of bone
metastases. It also explores the data available on the role of
bisphosphonates for bone
metastases from RCC, describes methods of assessing response to
therapy for bone
metastases and delineates future expectations for the treatment of bone
metastases from advanced RCC.