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Antiangiogenic drugs targeting the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways have revolutionized the management of metastatic clear cell renal cancer. Although the use of these agents clearly has an effect on the natural history of the disease, patients are not cured, and therapy-related toxicity is problematic. Typically, patients who progress on one agent are switched to alternatives. However, prospective evidence about the optimal drug sequence is limited.
To provide additional insight into sequential management of patients with metastatic renal cancer, international investigators conducted an industry-funded, phase III trial of second-line axitinib — a selective, second-generation (VEGF) …