Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France.
Nat Rev Clin Oncol. 2012 Apr 10;9(6):327-37. doi: 10.1038/nrclinonc.2012.59.
In metastatic renal cell carcinoma (mRCC), many factors influence clinical decisions, including histology, tumour burden, prognostic factors, comorbidities, and the ability of the patient to tolerate treatment. Progression-free survival (PFS) durations reported from randomized trials of targeted therapies vary considerably, in part because of differences in patient characteristics. For first-line therapy, an estimate of PFS with sunitinib, bevacizumab plus interferon, or sorafenib in a 'general' population is 8-9 months, but each regimen is suitable for different patient categories. For example, sunitinib is suitable for all-prognosis groups, particularly younger, fitter patients; pazopanib for patients with a good or intermediate prognosis; bevacizumab plus interferon for good-prognosis patients or those with indolent disease; and sorafenib for patients at all prognostic risk levels, particularly the elderly and those with comorbidities. Sequential therapy with targeted agents provides significant benefit, and should be considered in all patients who can tolerate such treatment. Level 1 evidence supports sequential use of tyrosine kinase inhibitors, as well as these agents followed by everolimus. We consider how patient characteristics have influenced the results of studies of first-line therapy, and we provide expert opinion on the most appropriate treatment choices for particular patient groups receiving first-line and second-line therapy.
在转移性肾细胞癌（mRCC）中，许多因素会影响临床决策，包括组织学、肿瘤负担、预后因素、合并症以及患者耐受治疗的能力。靶向治疗的随机试验报告的无进展生存期（PFS）差异很大，部分原因是患者特征的差异。对于一线治疗，在“一般”人群中，舒尼替尼、贝伐珠单抗加干扰素或索拉非尼的 PFS 估计为 8-9 个月，但每种方案都适合不同的患者类别。例如，舒尼替尼适用于所有预后组，特别是年轻、身体状况较好的患者；帕唑帕尼适用于预后良好或中等的患者；贝伐珠单抗加干扰素适用于预后良好的患者或疾病进展缓慢的患者；而索拉非尼适用于所有预后风险水平的患者，特别是老年患者和合并症患者。靶向药物的序贯治疗可显著获益，应考虑在所有能够耐受此类治疗的患者中使用。1 级证据支持使用酪氨酸激酶抑制剂序贯治疗，以及这些药物序贯使用后再使用依维莫司。我们考虑了患者特征如何影响一线治疗研究的结果，并就特定患者群体接受一线和二线治疗的最佳治疗选择提供了专家意见。
