Princess Margaret Hospital, Medical Oncology, Toronto, Ontario, Canada.
Ther Adv Med Oncol. 2010 Mar;2(2):75-83. doi: 10.1177/1758834009358417.
Bone is a common site of metastatic spread in patients with advanced renal cell carcinoma (RCC) occurring in around one-third of patients enrolled in clinical trials evaluating modern systemic therapies for this disease. Until recently, limited systemic therapeutic options were available for advanced RCC. Nowadays, a quiver of agents have demonstrated activity, including compounds targeting the vascular endothelial growth factor (VEGF) axis and those targeting the mammalian target of rapamycin (mTOR). Despite a detailed biological understanding of how these drugs work, their effect on bony metastases is less clear. Data suggesting that bisphosphonates (namely zoledronic acid) benefit patients with bone metastases from advanced RCC was gathered prior to the targeted therapy era; therefore, there is some uncertainty about their role in patients on modern RCC therapies. This review summarizes the current targeted therapies registered for use in advanced RCC and postulates how some of them might affect the behavior of bone metastases. It also explores the data available on the role of bisphosphonates for bone metastases from RCC, describes methods of assessing response to therapy for bone metastases and delineates future expectations for the treatment of bone metastases from advanced RCC.
骨骼是晚期肾细胞癌（RCC）患者转移的常见部位，约三分之一参加评估现代系统疗法治疗该疾病的临床试验的患者出现这种情况。直到最近，晚期 RCC 的系统治疗选择有限。如今，已有多种药物显示出疗效，包括靶向血管内皮生长因子（VEGF）轴的药物和靶向哺乳动物雷帕霉素靶蛋白（mTOR）的药物。尽管对这些药物的作用机制有详细的生物学了解，但它们对骨骼转移的影响不太清楚。在靶向治疗时代之前，收集了关于双膦酸盐（即唑来膦酸）使晚期 RCC 骨骼转移患者受益的数据；因此，对于接受现代 RCC 治疗的患者，其作用尚不确定。这篇综述总结了目前注册用于晚期 RCC 的靶向治疗方法，并推测其中一些方法可能会影响骨骼转移的行为。它还探讨了关于 RCC 骨骼转移中双膦酸盐作用的可用数据，描述了评估骨骼转移对治疗反应的方法，并阐述了治疗晚期 RCC 骨骼转移的未来期望。
