Miller Kurt
Klinik für Urologie, Charité Berlin.
Onkologie. 2010;33 Suppl 1:5-9. doi: 10.1159/000265688. Epub 2010 Jan 22.
Several molecular therapies have recently become available in first-line therapy of metastatic renal cell carcinoma (mRCC), thus marginalizing cytocine-based therapy. The primary aim of treatment in this situation is to delay progression with an increase in long-term life expectancy along with enhanced quality of life. At present, three new substances are available: Sunitinib, Temsirolimus, and - in combination with Interferon-alpha - Bevacizumab. To date, sufficient data is at hand for all drugs, which has resulted in a consolidation of therapeutic strategy. Selecting the best therapy is highly relevant in everyday practice, depending, among other things, on clinical evidence, guidelines, and the respective approval status. The prognostic score according to Motzer (MSKCC) plays a major role. It covers three prognostically relevant risk groups which are important for the preferential application of the new substances. Current recommendations suggest the application of Sunitinib and Bevacizumab plus Interferon-alpha for good and medium prognoses, with Sunitinib being regarded to be one therapy of first choice. It is the most frequently applied substance for this indication in Germany. The efficacy of Temsirolimus has been documented for patients with poor prognosis and it has been approved for this indication only. Hence, the mTor inhibitor should be the standard for this group of patients.
最近，几种分子疗法已用于转移性肾细胞癌（mRCC）的一线治疗，从而使基于细胞因子的疗法边缘化。这种情况下治疗的主要目标是延缓疾病进展，提高长期预期寿命并改善生活质量。目前有三种新药可供使用：舒尼替尼、替西罗莫司，以及与α干扰素联合使用的贝伐单抗。迄今为止，所有药物都有足够的数据，这使得治疗策略得以巩固。在日常临床实践中，选择最佳治疗方法非常重要，这尤其取决于临床证据、指南以及各自的获批情况。Motzer（纪念斯隆凯特琳癌症中心，MSKCC）预后评分起着重要作用。它涵盖三个与预后相关的风险组，这对于新药的优先应用很重要。目前的建议是，对于预后良好和中等的患者，应用舒尼替尼以及贝伐单抗加α干扰素，舒尼替尼被视为首选治疗方法之一。在德国，它是该适应症最常用的药物。替西罗莫司对预后不良的患者有效，并且仅被批准用于该适应症。因此，mTor抑制剂应该是这类患者的标准治疗药物。
