Albouy B, Gross Goupil M, Escudier B, Massard C
Institut Gustave-Roussy, Département de médecine, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
Bull Cancer. 2010;97:17-28. doi: 10.1684/bdc.2010.1067.
Advanced renal cell carcinoma is associated with a poor prognosis and is refractory to standard chemotherapy. Recent progress in the understanding of molecular biology and pathogenesis of renal cell cancer has been translated into the development of new therapeutic strategies. The management of metastatic RCC has been revolutionized with the development of targeted molecular therapies against VEGF-VEGFR and mTOR. Randomized phase III clinical trials demonstrated clinical benefit for patients with advanced RCC in overall survival and progression free survival. At the moment, six molecules have been approves in advanced RCC: cytokines (IL-2 and IFN), antiangiogenic therapies (sunitinib, sorafenib, bevacizumab) and mTOR inhibitors (Temsirolimus, everolimus). Nephrectomy is an important component of the multimodality treatment of mRCC. Prospective trials will be assessed the value of nephrectomy in patients treated by antiangiogenic therapies. Large randomized trial are ongoing to evaluate these new therapies in adjuvant setting.
晚期肾细胞癌预后较差，对标准化疗耐药。在肾细胞癌分子生物学和发病机制认识方面的最新进展已转化为新治疗策略的开发。针对VEGF-VEGFR和mTOR的靶向分子疗法的发展彻底改变了转移性肾细胞癌的治疗。随机III期临床试验证明，晚期肾细胞癌患者在总生存期和无进展生存期方面有临床获益。目前，已有六种分子被批准用于晚期肾细胞癌治疗：细胞因子（IL-2和IFN）、抗血管生成疗法（舒尼替尼、索拉非尼、贝伐单抗）和mTOR抑制剂（替西罗莫司、依维莫司）。肾切除术是转移性肾细胞癌多模式治疗的重要组成部分。前瞻性试验将评估肾切除术在接受抗血管生成疗法治疗的患者中的价值。大型随机试验正在进行，以评估这些新疗法在辅助治疗中的效果。
