Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois 60611, USA.
Oncologist. 2011;16 Suppl 2(Suppl 2):23-31. doi: 10.1634/theoncologist.2011-S2-23.
The introduction of molecular targeted therapies for patients with metastatic renal cell carcinoma has provided treatment options that are more efficacious and better tolerated than cytokine therapy, the previous standard of care. These advances have led to renewed efforts to define the health-related quality of life (HRQOL) impact of disease status stabilization or improvement versus that of treatment-associated adverse events. The distinct classes of targeted agents have unique AE profiles related to their specific targets; therefore, treatment considerations should include the patient's pretreatment HRQOL along with the known HRQOL effects of each drug. With more second- and third-line treatment options available for patients with metastatic renal cell carcinoma, HRQOL outcomes in earlier lines of therapy may guide treatment decisions for subsequent therapy, as poor HRQOL at therapy onset predicts poor survival. Both general and disease-specific instruments are used in clinical trials to reveal the impact of treatment on patient-reported outcomes. In this article, the common instruments used to assess HRQOL and the HRQOL outcomes observed in pivotal trials of targeted therapies are reviewed. Current data indicate that first-line therapy with sunitinib and first-line therapy in poor-prognosis patients with temsirolimus provide improved HRQOL compared with interferon-α. First- and second-line therapy with pazopanib and second-line therapy with everolimus and sorafenib maintained HRQOL levels similar to placebo, indicating that these agents do not worsen HRQOL. The HRQOL effects of bevacizumab plus IFN-α have not been reported. As new agents enter clinical investigation, HRQOL data can help determine their overall role in treatment.
分子靶向治疗为转移性肾细胞癌患者提供了比细胞因子治疗更有效且更耐受的治疗选择，后者是以前的标准治疗方法。这些进展促使人们重新努力定义疾病稳定或改善与治疗相关不良事件对健康相关生活质量（HRQOL）的影响。不同类别的靶向药物具有与其特定靶标相关的独特 AE 特征；因此，治疗考虑因素应包括患者治疗前的 HRQOL 以及每种药物已知的 HRQOL 影响。对于转移性肾细胞癌患者，有更多的二线和三线治疗选择，早期治疗线的 HRQOL 结果可能会指导后续治疗的决策，因为治疗开始时的 HRQOL 较差预示着生存较差。临床试验中使用一般和疾病特异性工具来揭示治疗对患者报告结果的影响。在本文中，回顾了用于评估 HRQOL 的常见工具以及靶向治疗的关键试验中观察到的 HRQOL 结果。目前的数据表明，与干扰素-α相比，舒尼替尼一线治疗和替西罗莫司治疗预后不良患者的一线治疗可改善 HRQOL。帕唑帕尼的一线和二线治疗以及依维莫司和索拉非尼的二线治疗保持与安慰剂相似的 HRQOL 水平，表明这些药物不会降低 HRQOL。贝伐单抗联合 IFN-α 的 HRQOL 影响尚未报道。随着新药物进入临床研究，HRQOL 数据可以帮助确定它们在治疗中的整体作用。
