Texas Oncology and Veterans Affairs Medical Center, Baylor College of Medicine, 501 Medical Center Blvd., Webster, TX 77598, USA.
Eur Urol. 2012 Feb;61(2):307-16. doi: 10.1016/j.eururo.2011.10.032. Epub 2011 Oct 30.
The expanding armamentarium of agents for the therapy of advanced clear cell renal cell carcinoma (RCC) warrants further investigation of optimal patient selection.
To analyze the second and subsequent line of targeted therapies for advanced RCC while integrating clinical and molecular markers and imaging.
Data were acquired from research published in peer-reviewed literature or presented at major conferences.
Following first-line vascular endothelial growth factor (VEGF) inhibitors, second-line therapy with everolimus, a mammalian target of rapamycin inhibitor, and axitinib, a VEGF receptor tyrosine kinase inhibitor, have demonstrated benefits in progression-free survival (PFS). Sorafenib, pazopanib, and axitinib have demonstrated extension of PFS following cytokines. Optimal patient selection based on biomarkers is undergoing investigation. Clinical trials evaluating novel agents and combinations should be preferred.
Currently, the sequence of therapy is based on patient and physician decision, which may be influenced by comorbidities and toxicity profiles.
针对晚期透明细胞肾细胞癌（RCC）的治疗手段不断增加，这就需要进一步研究最佳的患者选择。
在整合临床和分子标志物及影像学的基础上，分析晚期 RCC 的二线及后续靶向治疗。
数据来源于同行评议文献中的研究或重要会议上的报告。
在一线血管内皮生长因子（VEGF）抑制剂治疗后，二线使用哺乳动物雷帕霉素靶蛋白抑制剂依维莫司和 VEGF 受体酪氨酸激酶抑制剂阿昔替尼治疗可改善无进展生存期（PFS）。索拉非尼、帕唑帕尼和阿昔替尼在细胞因子治疗后也可延长 PFS。目前，基于生物标志物的最佳患者选择正在研究中。应优先选择评估新型药物和联合用药的临床试验。
目前，治疗顺序基于患者和医生的决策，这可能受到合并症和毒性特征的影响。
