Department of Oncology, Cambridge University Biomedical Research Campus, Addenbrooke's Hospital, Cambridge, United Kingdom.
Semin Oncol. 2013 Aug;40(4):482-91. doi: 10.1053/j.seminoncol.2013.05.004.
To date, no effective adjuvant treatment for renal cell carcinoma (RCC) has been described, but research in this area is important since the 5-year relapse rate for intermediate- and high-risk early-stage RCC is 30%-40%. Metastatic RCC can be treated successfully with immune therapy and targeted therapy. Adjuvant trials with immune therapy have been conducted, but they reported no benefit in disease-free survival, and clinical trials with targeted agents have not yet reported results. Further advances in our understanding of the molecular pathogenesis of RCC will identify additional potential targets for adjuvant treatment trials. Future challenges will consequently include target identification, as well as trial design to answer multiple trial questions concurrently, comprehensively, and economically. We review the past efforts, summarize the current adjuvant clinical trial landscape, and consider the challenges in adjuvant trials for RCC. Additionally, we identify potential future adjuvant trial treatments and propose an alternative design for future adjuvant clinical trials.
迄今为止，尚未描述出用于肾细胞癌 (RCC) 的有效辅助治疗方法，但该领域的研究非常重要，因为中高危早期 RCC 的 5 年复发率为 30%-40%。转移性 RCC 可以通过免疫治疗和靶向治疗成功治疗。已经进行了免疫治疗的辅助试验，但它们并未报告在无病生存期方面有获益，而靶向药物的临床试验尚未报告结果。我们对 RCC 分子发病机制的进一步了解将确定辅助治疗试验的其他潜在靶标。因此，未来的挑战将包括确定靶标，以及设计同时全面而经济地回答多个试验问题的试验。我们回顾了过去的努力，总结了当前的辅助临床试验现状，并考虑了 RCC 辅助试验中的挑战。此外，我们确定了潜在的未来辅助试验治疗方法，并为未来的辅助临床试验提出了替代设计。
