Gschwend Jürgen E
Urologische Klinik und Poliklinik der Technischen Universität, München, Klinikum rechts der Isar, München.
Onkologie. 2010;33 Suppl 1:10-1. doi: 10.1159/000265687. Epub 2010 Jan 22.
The treatment objective in the metastatic situation is to delay progression while maintaining the best possible quality of life. Since several targeted therapies with different modes of action already exist, sequence therapy is increasingly being considered. Current data regarding sequential treatment is still insufficient and several approaches are being tested in ongoing clinical studies. Based on current data, guidelines, and the therapeutic algorithms supported by national and international professional associations, the German Cancer Society's interdisciplinary task force on renal cell carcinoma (RCC) recommends the following approach: since the efficacy of cytokines is very limited after a previous cytokine-based therapy has failed, Sorafenib or Sunitinib are the treatment of choice. Treatment with other targeted substances is recommended after first-line therapy has failed as a number of retrospective studies have documented relevant activity. Everolimus currently is the treatment of first choice when VEGF-directed therapy has failed. Based on the results of phase II studies, other tyrosine kinase inhibitors can alternatively be applied.
转移性肾癌的治疗目标是在维持尽可能最佳生活质量的同时延缓疾病进展。由于已经存在几种具有不同作用方式的靶向治疗，序贯治疗越来越受到关注。目前关于序贯治疗的数据仍然不足，正在进行的临床研究中正在测试几种方法。基于目前的数据、指南以及国家和国际专业协会支持的治疗算法，德国癌症协会肾细胞癌（RCC）跨学科工作组推荐以下方法：由于在先前基于细胞因子的治疗失败后，细胞因子的疗效非常有限，索拉非尼或舒尼替尼是首选治疗药物。在一线治疗失败后，推荐使用其他靶向药物进行治疗，因为一些回顾性研究已经证明了其相关活性。当VEGF导向治疗失败时，依维莫司目前是首选治疗药物。根据II期研究结果，也可以应用其他酪氨酸激酶抑制剂。
