Department of Urology, University of Munich, Klinikum Grosshadern, Munich, Germany.
Urol Oncol. 2010 Mar-Apr;28(2):139-44. doi: 10.1016/j.urolonc.2009.03.033. Epub 2009 Jul 3.
Former systemic therapy for metastatic renal cell cancer (mRCC) based on immunomodulation could achieve complete remissions (CR) in only some patients. Angiogenic therapy with sunitinib, sorafenib, and temsirolimus changed the paradigm of treating mRCC based on a doubled progression-free survival (PFS) and 10% to 30% of patients achieving partial remission (PR). Unfortunately, CR is rarely seen. Within our patients we could achieve some CR, which we are presenting in this study.
We assessed 194 consecutive patients of an institutional database that were treated for mRCC with either sorafenib or sunitinib between 05/2006 and 12/2007. Restaging with repeated high-resolution computed tomography (CT) of thorax and abdomen was performed in an 8 to 10 weeks interval. Five patients who achieved CR in repeated CT under therapy are included in this analysis.
Of the patients in whom we achieved CR, two were female and three were male. Median age was 63.2 years (range 52-70). All patients had clear cell histology. In three of the five patients, CR was achieved by surgery after partial remission, and in two patients it was achieved by sole medical therapy. All patients remained in CR until now with a median duration of CR of 24 months (range 24-29 months). One patient still is on therapy, while four patients do not receive any systemic treatment.
We proof long-term confirmed CR in mRCC achieved by anti-angiogenic therapy alone or in combination with surgery. Combining surgery and anti-angiogenic therapy based on sorafenib and sunitinib could render patients free of disease even after repeated cycles of systemic treatment.
以前转移性肾细胞癌（mRCC）的全身治疗基于免疫调节，只有少数患者能达到完全缓解（CR）。索拉非尼、舒尼替尼和替西罗莫司的抗血管生成治疗改变了治疗 mRCC 的范例，使无进展生存期（PFS）翻倍，10%至 30%的患者达到部分缓解（PR）。不幸的是，CR 很少见。在我们的患者中，我们可以实现一些 CR，我们在本研究中进行了介绍。
我们评估了机构数据库中 194 例连续患者，他们在 2006 年 5 月至 2007 年 12 月期间接受了索拉非尼或舒尼替尼治疗 mRCC。在 8 至 10 周的时间间隔内，对胸部和腹部进行重复高分辨率计算机断层扫描（CT）进行重新分期。在治疗下通过重复 CT 达到 CR 的 5 例患者包含在此分析中。
在达到 CR 的患者中，有 2 名女性和 3 名男性。中位年龄为 63.2 岁（范围为 52-70）。所有患者均为透明细胞组织学。在这 5 例患者中，有 3 例通过部分缓解后的手术达到 CR，有 2 例通过单纯药物治疗达到 CR。所有患者直到现在仍处于 CR 状态，CR 的中位持续时间为 24 个月（范围为 24-29 个月）。1 例患者仍在接受治疗，而 4 例患者未接受任何全身治疗。
我们证明了单独使用抗血管生成治疗或联合手术在 mRCC 中获得长期确认的 CR。结合手术和基于索拉非尼和舒尼替尼的抗血管生成治疗可以使患者即使在重复全身治疗后也能免于疾病。
