University Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 2QQ, UK.
Target Oncol. 2010 Jun;5(2):139-56. doi: 10.1007/s11523-010-0149-2. Epub 2010 Aug 6.
Patients with renal cell carcinoma (RCC) exhibit a spectrum of clinical outcomes, with some patients following an indolent clinical course and others displaying rapidly advancing disease. As evidence points to RCC being largely refractory to traditional chemotherapy and radiotherapy strategies, immunotherapeutic approaches played a dominant role in the management of metastatic RCC for a quarter of a century. Management of this challenging tumor has been revolutionized by the incorporation of molecularly targeted therapies such as inhibitors of pathways involving tyrosine kinase signaling and the mammalian target of rapamycin (mTOR). The improvements in disease stabilization and survival seen with these agents has meant that molecularly targeted therapy now forms the foundation for treating RCC and has resulted in a multitude of studies investigating similar compounds for efficacy in RCC. Despite this, the rationale for using immunomodulatory regimens remains strong and its ongoing place in this era of targeted treatments continues to pose interesting clinical questions. The challenge of maintaining durable responses from our current therapies persists and this review highlights the plethora of options now available in RCC treatment and the directions in which modern management are heading.
患有肾细胞癌 (RCC) 的患者表现出一系列的临床结果，有些患者表现为惰性的临床过程，而有些患者则表现为疾病迅速进展。由于证据表明 RCC 对传统的化疗和放疗策略基本没有反应，免疫治疗方法在治疗转移性 RCC 的四分之一个世纪中占据了主导地位。通过引入靶向治疗方法，如酪氨酸激酶信号通路抑制剂和哺乳动物雷帕霉素靶蛋白 (mTOR)，对这种具有挑战性的肿瘤的治疗进行了革命性的改变。这些药物在稳定疾病和提高生存率方面的改善意味着，分子靶向治疗现在已成为治疗 RCC 的基础，并导致了大量研究调查类似化合物在 RCC 中的疗效。尽管如此，使用免疫调节方案的理由仍然很充分，其在这个靶向治疗时代的持续存在仍然提出了有趣的临床问题。如何保持我们当前治疗方法的持久反应仍然是一个挑战，这篇综述强调了现在 RCC 治疗中可用的大量选择以及现代管理的方向。
