Biswas Swethajit, Kelly John, Eisen Tim
Department of Oncology, Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
Oncologist. 2009 Jan;14(1):52-9. doi: 10.1634/theoncologist.2008-0121. Epub 2009 Jan 15.
Cytoreductive nephrectomy in combination with adjuvant immunotherapy is an established treatment option for selected patients with metastatic clear-cell renal cell carcinoma (mCC-RCC). Multitargeted antiangiogenic and mammalian target of rapamycin tyrosine kinase inhibitors (TKIs) are now established treatment paradigms in patients with mCC-RCC. Given that all the recent seminal TKI trials in mCC-RCC provide no evidence base for the use of cytoreductive nephrectomy in the TKI era, it is not presently clear where such a surgical approach fits into the treatment paradigm. This review summarizes the evidence for the management of mCC-RCC and outlines novel approaches to be tested within future trials if the initial proposed phase III trials in this setting, using sunitinib, are successful. Overall, two principal questions need addressing. First, is cytoreductive nephrectomy necessary in the TKI era? Second, if so, what is the most appropriate scheduling of TKI therapy with cytoreductive nephrectomy?
减瘤性肾切除术联合辅助免疫治疗是特定转移性透明细胞肾细胞癌（mCC-RCC）患者的既定治疗选择。多靶点抗血管生成和雷帕霉素酪氨酸激酶抑制剂（TKIs）目前是mCC-RCC患者的既定治疗模式。鉴于近期所有关于mCC-RCC的关键TKI试验均未为TKI时代使用减瘤性肾切除术提供证据基础，目前尚不清楚这种手术方法在治疗模式中的位置。本综述总结了mCC-RCC管理的证据，并概述了如果在这种情况下最初提议的使用舒尼替尼的III期试验成功，未来试验中有待测试的新方法。总体而言，有两个主要问题需要解决。第一，在TKI时代，减瘤性肾切除术是否必要？第二，如果必要，TKI治疗与减瘤性肾切除术的最合适时间安排是什么？
