Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Boul. René-Lévesque East, Suite 228, Montreal, QC, Canada H2X 1P1.
Ther Adv Urol. 2013 Apr;5(2):121-8. doi: 10.1177/1756287212466128.
Targeted therapies have introduced a paradigm shift in the management of metastatic renal cell carcinoma. Currently, four molecules (sunitinib, pazopanib, bevacizumab plus interferon, temsirolimus) are considered in first-line therapy, and three other molecules for second, or subsequent lines of therapy (everolimus, axitinib, sorafenib). In addition, other molecules and sequencing schemes are being tested in ongoing phase II/III studies. We conducted a systematic review using PubMed and several other databases up to December 2011 of prospective and retrospective studies on treatment management of metastatic renal cell carcinoma using targeted therapies, with a special focus on use of sequential treatment. Based on phase III data, the optimal sequencing scheme for patients with clear cell or even non-clear cell histological subtype appears to consist of sunitinib, followed by axitinib, followed by everolimus. Subsequent treatment options rely on lower evidence studies and could consist of fourth-line sorafenib or sunitinib rechallenge. Such therapies would qualify as last recourse options. In another context, temsirolimus may be used in patients who fulfill the Memorial Sloan-Kettering Cancer Center poor risk criteria or who have poor performance status. We conclude that in the current setting, sequential therapy represents the cornerstone of effective management of metastatic renal cell carcinoma.
靶向治疗在转移性肾细胞癌的治疗管理中带来了一种范式转变。目前，有四种分子（舒尼替尼、帕唑帕尼、贝伐珠单抗加干扰素、替西罗莫司）被认为是一线治疗药物，另外三种分子用于二线或后续治疗（依维莫司、阿昔替尼、索拉非尼）。此外，其他分子和序贯方案正在正在进行的 II/III 期研究中进行测试。我们使用 PubMed 和其他几个数据库进行了系统评价，截至 2011 年 12 月，对使用靶向治疗治疗转移性肾细胞癌的治疗管理进行了前瞻性和回顾性研究，特别关注序贯治疗的使用。基于 III 期数据，对于透明细胞或甚至非透明细胞组织学亚型的患者，最佳的序贯治疗方案似乎是舒尼替尼，其次是阿昔替尼，其次是依维莫司。后续的治疗选择依赖于较低证据的研究，可能包括四线索拉非尼或舒尼替尼再挑战。这些治疗方法可以作为最后的治疗选择。在另一种情况下，替西罗莫司可用于符合纪念斯隆-凯特琳癌症中心不良风险标准的患者或表现状态较差的患者。我们的结论是，在当前情况下，序贯治疗是有效治疗转移性肾细胞癌的基石。
