Renal cell carcinoma (RCC) is a malignancy that in advanced disease, is highly resistant to systemic thera-pies. Elucidation of the angiogenesis pathways and their intrinsic signaling interactions with the genetic and meta-bolic disturbances within renal cell carcinoma variants has ushered in the era of " targeted therapies " . Advanced surgical interventions and novel drugs targeting VEGF and mTOR, have improved patient survival and prolonged clinically stable-disease states. This review discusses the current understanding of diagnostic challenges and the mechanism-based clinical evidence on therapeutic management of advanced RCC.
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