American Board of Internal Medicine (ABIM) Certification Practice Exam

The first-line treatment for most patients with metastatic renal cell carcinoma typically involves which type of therapy?

1. Interferon therapy

2. VEGF tyrosine kinase inhibitors

3. mTOR inhibitors

4. Chemotherapy

The correct answer is: VEGF tyrosine kinase inhibitors

The first-line treatment for most patients with metastatic renal cell carcinoma (RCC) typically involves the use of VEGF (vascular endothelial growth factor) tyrosine kinase inhibitors. These agents work by targeting the pathways that contribute to tumor angiogenesis, which is the process by which tumors develop their own blood supply to support growth and metastasis. By inhibiting these pathways, VEGF tyrosine kinase inhibitors can effectively reduce tumor growth and prolong survival in patients with metastatic RCC. This approach is supported by clinical guidelines and multiple studies demonstrating the efficacy of VEGF inhibitors like sunitinib and pazopanib as foundational therapies in this patient population. These medications have become standard due to their ability to improve outcomes compared to older treatments without similar targeted action, such as interferon or conventional chemotherapy. While mTOR inhibitors and immunotherapies hold therapeutic value in specific patient scenarios, they are generally considered after first-line therapy or in situations of treatment resistance. Therefore, the use of VEGF tyrosine kinase inhibitors as the initial treatment represents a significant advancement in the management of metastatic RCC.