Speca JoEllen, Yenser Sarah, Creel Patricia, George Daniel
Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Clin Genitourin Cancer. 2006 Dec;5 Suppl 1:S24-30. doi: 10.3816/cgc.2006.s.004.
With the approval of sunitinib and sorafenib, 2 new multitargeted tyrosine kinase inhibitors, for the treatment of advanced renal cell carcinoma (RCC), the natural history and prognosis of patients with this disease has significantly improved. These drugs were approved based upon clinical data demonstrating robust, unprecedented response rates in one case and dramatic prolongation of progression-free survival in the other. In both cases, these results were seen in study patients in whom standard therapy had failed and who, on average, carried substantial disease burden. Important challenges today include integrating these therapies with other standard therapeutic options and into other advanced-stage RCC patient populations. This article addresses current data and practice patterns regarding the clinical use of tyrosine kinase inhibitors in patients with advanced-stage RCC, including dose modifications and alternative dosing, the current role of debulking nephrectomy, and use in patients with indolent disease. Finally, a summary of the more common side effects and management strategies for these is also discussed. Ultimately, more clinical data is needed to address the chronic use of these agents alone, in combination with other agents, with radiation therapy, and in sequence.
随着两种新型多靶点酪氨酸激酶抑制剂舒尼替尼和索拉非尼获批用于治疗晚期肾细胞癌（RCC），该疾病患者的自然病程和预后有了显著改善。这两种药物获批是基于临床数据，其中一种药物显示出强劲且前所未有的缓解率，另一种则显著延长了无进展生存期。在这两种情况下，这些结果均出现在标准治疗失败且平均疾病负担较重的研究患者中。如今的重要挑战包括将这些疗法与其他标准治疗选择相结合，并应用于其他晚期RCC患者群体。本文阐述了晚期RCC患者临床使用酪氨酸激酶抑制剂的当前数据和实践模式，包括剂量调整和替代给药方式、减瘤性肾切除术的当前作用以及在惰性疾病患者中的应用。最后，还讨论了这些药物更常见的副作用及管理策略。最终，需要更多临床数据来解决这些药物单独长期使用、与其他药物联合使用、与放射治疗联合使用以及序贯使用的问题。
