Baylor University Medical Center, Dallas, TX 75246, United States.
Crit Rev Oncol Hematol. 2011 Jan;77(1):48-62. doi: 10.1016/j.critrevonc.2010.07.018. Epub 2010 Aug 11.
Sequential use of targeted therapies is a common practice in the treatment of advanced renal cell carcinoma (RCC) that extends disease control beyond the benefit of single therapies. After disease progression on one agent, treatment with a second targeted agent as subsequent-line therapy provides disease control and additional progression-free survival. The most effective sequence of targeted agents has yet to be determined. Results from the only trial of sequenced targeted agents support the use of mammalian target of rapamycin inhibitors after resistance develops to vascular endothelial growth factor (VEGF) inhibitors. Preliminary data suggest an antitumor effect of VEGF-targeted therapy in RCC, despite prior exposure to other VEGF-targeted therapies. The safety and efficacy of sequential therapies are currently under investigation; the optimal sequence may vary among patients to accommodate comorbid conditions or different disease stages. The current evidence supporting sequential use of targeted agents in RCC is presented in this review.
序贯使用靶向治疗是治疗晚期肾细胞癌（RCC）的常见做法，它可以延长疾病控制时间，超越单一疗法的获益。在一种药物出现疾病进展后，使用第二种靶向药物作为后续治疗可提供疾病控制和额外的无进展生存期。最有效的靶向药物序贯方案尚未确定。唯一一项序贯靶向药物试验的结果支持在对血管内皮生长因子（VEGF）抑制剂产生耐药后使用哺乳动物雷帕霉素靶蛋白抑制剂。初步数据表明，尽管先前已暴露于其他 VEGF 靶向治疗药物，VEGF 靶向治疗在 RCC 中仍具有抗肿瘤作用。序贯治疗的安全性和有效性正在研究中；最佳的序贯方案可能因患者的合并症或不同疾病阶段而异。本文综述了目前支持 RCC 中序贯使用靶向药物的证据。
