Bitting Rhonda L, Madden John, Armstrong Andrew J
Department of Medicine, Division of Medical Oncology, Duke University and the Duke Cancer Institute, Durham, NC 27710, USA.
Curr Clin Pharmacol. 2011 Aug;6(3):169-80. doi: 10.2174/157488411797189460.
The advent of targeted systemic therapies has significantly improved treatment options for patients with metastatic renal cell carcinoma (RCC). Multiple agents that inhibit angiogenesis cell growth and proliferation via the VEGF and mTOR (TORC1) pathways have been USFDA-approved for locally advanced or metastatic renal cell carcinoma in recent years although the majority of clinical trials have focused only on clear cell RCC. While clear cell RCC is the most common histologic subtype nearly 25% of RCC cases are histologic variants representing a diverse group of diseases with different prognoses underlying biology and molecular targets and therapies. This review will focus on the incidence clinical and pathologic features pathogenesis and treatment strategies of non-clear cell RCC in both the adjuvant and metastatic setting. These non-clear cell subtypes include papillary type 1 and type 2 chromophobe translocation carcinoma and collecting duct RCC. Controlled studies in these relatively rare subgroups are needed to inform upon clinical practice which is currently based on small series of uncontrolled studies. Ongoing clinical trials and areas of future research will be discussed.
靶向全身治疗的出现显著改善了转移性肾细胞癌（RCC）患者的治疗选择。近年来，多种通过VEGF和mTOR（TORC1）途径抑制血管生成、细胞生长和增殖的药物已获美国食品药品监督管理局（USFDA）批准用于局部晚期或转移性肾细胞癌，尽管大多数临床试验仅聚焦于透明细胞RCC。虽然透明细胞RCC是最常见的组织学亚型，但近25%的RCC病例为组织学变异型，代表了一组具有不同预后、潜在生物学特性、分子靶点及治疗方法的多种疾病。本综述将聚焦于非透明细胞RCC在辅助和转移情况下的发病率、临床和病理特征、发病机制及治疗策略。这些非透明细胞亚型包括1型和2型乳头状癌、嫌色细胞癌、易位性癌以及集合管RCC。需要在这些相对罕见的亚组中开展对照研究，以为目前基于少量非对照研究系列的临床实践提供依据。还将讨论正在进行的临床试验及未来的研究领域。
