Targeted therapy for locally advanced renal cell carcinoma.

A number of molecularly targeted agents are now available for patients with metastatic renal cell carcinoma. Their role in locally advanced disease is not well defined, and the mechanisms of progression in the high-risk patient are poorly understood. For an agent to be effective in locally advanced renal cell carcinoma it needs to be able to downstage primary tumors, and to prevent the formation of metastases. In this review, we summarize clinical trials assessing the ability of these new agents to cytoreduce primary tumors, and explore available evidence on their ability to prevent the formation of metastases. Ongoing adjuvant clinical trials assessing molecularly targeted agents in the high-risk setting will provide valuable information on their utility in this patient population. Future trials using agents with optimized cytoreductive capabilities in conjunction with therapies capable of preventing metastatic dissemination may improve the outcomes of patients with locally advanced renal cell carcinoma.