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Introduction

Prognostic factor models can provide important information to help patients and clinicians make treatment decisions. These decisions have become more complex in the selection of treatment for patients with metastatic renal cell carcinoma (RCC). Within the past 2 years, three new agents—sorafenib (Nexavar), sunitinib (Sutent), and temsirolimus (Torisel)—have gained approval for RCC, and it is likely that more will follow in the near future. In addition, the role of the older cytokine therapies, while clearly diminished, may still be important in selected patients. 

Despite remarkable progress in the therapy of metastatic RCC, it is apparent that tumor characteristics and prognostic factors remain important determinants of disease control and survival. Patients with multiple adverse prognostic factors usually have been excluded from participation in clinical trials of cytokine therapy, and only a minority of such patients has been included in the recent trials of targeted agents. Selecting therapy for these poor risk or poor prognosis patients is an important clinical challenge.

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