Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicetre, France.
Eur Urol. 2011 Oct;60(4):684-90. doi: 10.1016/j.eururo.2011.06.017. Epub 2011 Jun 24.
Until the development of novel targeted agents directed against angiogenesis and tumour growth, few treatment options have been available for the treatment of metastatic renal-cell carcinoma (mRCC).
This review discusses current targeted therapies for mRCC and provides consensus statements regarding treatment algorithms.
Medical literature was retrieved from PubMed up to April 2011. Additional relevant articles and abstract reviews were included from the bibliographies of the retrieved literature.
Targeted treatment for mRCC can be categorized for the following patient groups: previously untreated patients, those refractory to immunotherapy, and those refractory to vascular endothelial growth factor (VEGF)-targeted therapy. Sunitinib and bevacizumab combined with interferon alpha are generally considered first-line treatment options in patients with favourable or intermediate prognoses. Temsirolimus is considered a first-line treatment option for poor-risk patients. Either sorafenib or sunitinib may be valid second-line treatments for patients who have failed prior cytokine-based therapies. For patients refractory to treatment with VEGF-targeted therapy, everolimus is now recommended. Pazopanib is a new treatment option in the first- and second-line setting (after cytokine failure). Sequential and combination approaches, and the roles of nephrectomy and tumour metastasectomy will also be discussed.
Increasing clinical evidence is clarifying appropriate first- and second-line treatments with targeted agents for patients with mRCC. Based on phase 2 and 3 trials, a sequential approach is most promising, while combination therapy is still investigational. The role of nephrectomy in mRCC is being evaluated in ongoing phase 3 clinical trials.
在新型靶向药物针对血管生成和肿瘤生长开发出来之前，转移性肾细胞癌（mRCC）的治疗选择非常有限。
本文讨论了 mRCC 的当前靶向治疗方法，并就治疗方案提供了共识意见。
从 PubMed 检索到截至 2011 年 4 月的医学文献。还从检索文献的参考文献中纳入了其他相关文章和综述。
mRCC 的靶向治疗可分为以下患者群体：初治患者、对免疫治疗耐药的患者和对血管内皮生长因子（VEGF）靶向治疗耐药的患者。舒尼替尼和贝伐单抗联合干扰素α通常被认为是预后良好或中等的患者的一线治疗选择。替西罗莫司被认为是预后不良患者的一线治疗选择。对于那些对细胞因子治疗失败的患者，索拉非尼或舒尼替尼可能是有效的二线治疗选择。对于对 VEGF 靶向治疗耐药的患者，现在推荐使用依维莫司。帕唑帕尼是一线和二线治疗的新选择（细胞因子治疗失败后）。还将讨论序贯和联合方法以及肾切除术和肿瘤转移切除术的作用。
越来越多的临床证据阐明了针对 mRCC 患者使用靶向药物的适当一线和二线治疗方法。基于 2 期和 3 期试验，序贯方法最有前途，而联合治疗仍在研究中。肾切除术在 mRCC 中的作用正在正在进行的 3 期临床试验中进行评估。
