Axitinib in renal cell carcinoma: now what do we do?

Axitinib is a potent small molecule tyrosine kinase inhibitor with relative specificity for vascular endothelial growth factor (VEGF) receptors. Initial studies indicated promising levels of activity and a favourable safety profile in advanced renal cell carcinoma (RCC) and the drug has now been approved for use in the second line setting in this disease. It was logical then to move axitinib into trials in the treatmentnaïve population. The AGILE clinical trial compared axitinib to another drug, sorafenib, which has broader specificity for its kinase targets. The AGILE trial failed to meet its primary objective of improving progression-free survival (PFS). This editorial examines the trial in detail and speculates upon possible reasons for this failure and what the future might hold for axitinib and other therapies.