Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux.
Ann Oncol. 2013 Dec;24(12):2935-42. doi: 10.1093/annonc/mdt288. Epub 2013 Aug 7.
There are now a range of effective targeted agents available for the first- and second-line treatment of advanced renal cell carcinoma (RCC). However, patients with advanced RCC have varied responses to therapy; some experience long-term responses while others may not respond, or even progress rapidly. Characteristics or markers that could be used to determine which patients will benefit most from which agent may enable us to select the optimal treatment of each individual patient, thereby improving efficacy and avoiding unnecessary toxic effects. These characteristics may be at the cellular or genetic level. Alternatively, the occurrence of adverse events may act as surrogate markers of a drug's on treatment activity, enabling prediction of outcomes during treatment. Recently, it has been suggested that during some targeted therapy for advanced RCC, the occurrence of specific adverse events, such as hypertension, hypothyroidism, hand-foot syndrome or fatigue/asthenia, may be associated with improved efficacy. This article reviews the evidence supporting clinical biomarkers in patients with advanced RCC receiving targeted agents. We also consider how these clinical biomarkers may affect the future management of patients with advanced RCC.
目前有一系列有效的靶向药物可用于治疗晚期肾细胞癌 (RCC) 的一线和二线治疗。然而，患有晚期 RCC 的患者对治疗的反应各不相同；一些患者长期反应良好，而另一些患者可能没有反应，甚至迅速进展。能够用于确定哪些患者将从哪种药物中获益最大的特征或标志物可能使我们能够为每个患者选择最佳治疗方法，从而提高疗效并避免不必要的毒性作用。这些特征可能在细胞或遗传水平上。或者，不良事件的发生可以作为药物治疗活性的替代标志物，从而能够在治疗期间预测结果。最近有人提出，在接受晚期 RCC 的某些靶向治疗期间，特定不良反应的发生，如高血压、甲状腺功能减退、手足综合征或疲劳/乏力，可能与疗效改善相关。本文综述了支持接受靶向药物治疗的晚期 RCC 患者的临床生物标志物的证据。我们还考虑了这些临床生物标志物如何影响晚期 RCC 患者的未来管理。
