Maráz Anikó
Szegedi Tudományegyetem, Általános Orvostudományi Kar Onkoterápiás Klinika Szeged Korányi fasor 12. 6720.
Orv Hetil. 2011 Apr 24;152(17):655-62. doi: 10.1556/OH.2011.29100.
Therapeutic options in advanced renal-cell cancer have expanded through better understanding of molecular pathology and development of novel targeted therapeutics. Vascular endothelial growth factor, the key ligand of angiogenesis, has a major role in the progression of vascularized kidney tumors and this is the target molecule of modern medications. The three types of the mechanism of action of current therapies are: monoclonal antibodies blocking directly vascular endothelial growth factor ligand (bevacizumab), tyrosine-kinase inhibitors blocking vascular endothelial growth factor receptors (sorafenib, sunitinib, pazopanib) and inhibitors of the intracellular mTOR-kinase (temsirolimus, everolimus). Based on randomized studies, sunitinib, pazopanib or interferon-α-bevacizumab combination should be the first-line therapy in patients with good/moderate prognosis, while temsirolimus is recommended in those with poor prognosis. Following an ineffective cytokine therapy sorafenib or pazopanib are the second-line treatment. In case of tyrosine-kinase inhibitor inefficacy, current evidence favors everolimus. Patient outcome can further be improved by the involvement of more modern and effective target products.
通过对分子病理学的深入理解以及新型靶向治疗药物的研发，晚期肾细胞癌的治疗选择得到了扩展。血管内皮生长因子作为血管生成的关键配体，在血管化肾肿瘤的进展中起着重要作用，它是现代药物的靶分子。当前治疗的三种作用机制类型分别为：直接阻断血管内皮生长因子配体的单克隆抗体（贝伐单抗）、阻断血管内皮生长因子受体的酪氨酸激酶抑制剂（索拉非尼、舒尼替尼、帕唑帕尼）以及细胞内mTOR激酶抑制剂（替西罗莫司、依维莫司）。基于随机研究，舒尼替尼、帕唑帕尼或干扰素-α-贝伐单抗联合治疗应作为预后良好/中等患者的一线治疗方案，而替西罗莫司则推荐用于预后较差的患者。在细胞因子治疗无效后，索拉非尼或帕唑帕尼为二线治疗。若酪氨酸激酶抑制剂治疗无效，目前的证据支持依维莫司。更多现代且有效的靶向产品的应用可进一步改善患者的预后。
