The medical therapies of renal cell carcinoma include chemotherapy, hormone treatment, immunotherapy, and targeted therapy.

Medical therapy is generally reserved for patients with metastatic disease when surgical management is not feasible. The goal of medical therapy is to achieve an appropriate overall quality of life and to control tumor burden. Most patients who require systemic medical therapy continue treatment chronically.

In summary, the following table shows the response rate of various treatment options for renal cell carcinoma:

Immunotherapy is considered the first line therapy for patients with metastatic renal cell carcinoma.^{[19][20][21][5][6][22]}

• Aldesleukin (IL2)
  • It is considered as a preferable option for patients with good cardiovascular performance status.
  • It is associated with capillary leak syndrome.
• Interferon Alfa
  • It is beneficial in renal cell carcinoma, particularly when combined with aldesleukin.
• Nivolumab plus ipilimumab
• Pembrolizumab
• Atezolizumab

• Sunitinib malate is a tyrosine kinase inhibitor of VEGF receptors considered as first line therapy.^[23]
• Sunitinib has been studied compare to interferon and has shown advantage in both survival and response rate.^[9][10][11]
• Associated toxicity includes fatigue, hand-foot syndrome, diarrhea, hypertension, hypothyroidism, and decreased left ventricular function.^[24][25][26]

• Sorafenib tosylate is a kinase inhibitor of VEGF receptor, often regarded as a weaker inhibitor than sunitinib.
• Sorafenib has shown approximately a significant additional 3 month progression free survival and similarly, a significant additional median overall survival of approximately 3.4 months.^[12]
• Associated toxicity includes those of sunitinib but at a lesser rate.

• Monoclonal antibody against VEGF considered first line therapy in Europe.^[27][1]
• Response rate and progression free survival are both increased with combination with inferferon.^[14]
• Toxicity includes fatigue, anorexia, hypertension, and proteinuria.^[1]

Epidermal growth factor receptor (EGFR) inhibitors are used less frequently than VEGF inhibitors. Examples of EGFR inhibitors are listed below^[28]:

• Panitumumab
• Gefitinib
• Erlotinib

• Temsirolimus (CCI-779) is often reserved only for high risk patients with metastatic disease.
• Temsirolimus monotherapy is regarded as superior to interferon monotherapy with no additional advantage in combination therapy of both drugs.^[29][30]
• Toxicity includes anemia, asthenia, dyspnea, dyslipidemia, and hyperglycemia. New studies have shown added benefit when temsirolimus is combined with everolimus.^[31]

• Gemcitabine/Fluorouracil
  • Use of chemotherapy, such as gemcitabine/fluorouracil is low in renal cell carcinoma.^[32]
  • Combination of both chemotherapeutic agents yield better response rates than either alone.

• Vinblastine
  • Vinblastine has shown to be ineffective in metastatic renal cell carcinoma.^[33]
  • Combination with other agents has not shown added benefit either.^[34]

• Large randomized trials did not yield high responses as anti-tumor effects when used alone or when used with other medications.^[33][34]
• Their role is reserved for palliative care.^[2][3][4]