Expanding the boundaries of clinical practice: building on experience with targeted therapies

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Abstract
Background: Advances in understanding of the mechanisms underlying cancers such as renal cell carcinoma (RCC) and gastrointestinal stromal tumour (GIST) have enabled the identification of therapeutic targets. Targeted agents have considerably improved the prognosis for patients with these cancers. Design: This supplement reviews approaches to the management of metastatic RCC (mRCC) and advanced GIST using targeted agents and examines clinical evidence supporting these strategies. Future developments in RCC and GIST treatment are also considered. Results: In a phase III trial in 750 treatment-naive mRCC patients, the multitargeted tyrosine kinase inhibitor sunitinib conferred median progression-free survival more than double that seen with interferon-alfa and median overall survival exceeding 2 years. Sunitinib is now considered the reference standard of care for first-line treatment of mRCC, and bevacizumab plus interferon-alfa is also recommended in this setting. As a result, the treatment algorithm has evolved to reflect the role of sunitinib and other targeted agents for mRCC. For advanced GIST, sunitinib has been shown to extend survival in patients with imatinib-resistant/-intolerant GIST and is licensed multinationally in this setting. Conclusions: Developments with targeted agents may enhance the treatment of patients with advanced RCC and GIST and offer benefits in other settings, such as adjuvant and neoadjuvant therapies.

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