Miller K, Bergmann L, Doehn C, Grünwald V, Gschwend J, Kuczyk M
Klinik für Urologie, Charité - Universitätsmedizin Berlin.
Medizinische Klinik II, J.W. Goethe-Universität Frankfurt/Main.
Aktuelle Urol. 2015 Mar;46(2):151-7. doi: 10.1055/s-0035-1547281. Epub 2015 Apr 21.
Patients with metastatic renal cell carcinoma have a life-limiting prognosis. Therefore, the aim of therapy is normally palliative care. Nevertheless, substantial achievements have been made in the past years. Cytokines as long-term standard therapy have been replaced by new targeted therapies. Sunitinib, the combination of bevacizumab+interferon-alfa, pazopanib and temsirolimus are now approved for first-line therapy. Sunitinib and pazopanib can also be administered as second-line options - for pazopanib the use is restricted to the event of cytokine failure. Everolimus (after TKI therapy) und sorafenib (after cytokines) are other compounds now available for second-line therapy. In addition, axitinib was approved for second-line therapy after failure of sunitinib or cytokines. For questions regarding the optimal sequence, first study results are now available from the phase III trial.The purpose of an interdisciplinary expert meeting held in 2014 was to debate about which criteria should influence the therapy decision. The members discussed several aspects of treating patients with the disease. Results from the 2012 conference provided the basis for the 2014 meeting 1. As in previous years, the experts intended to provide common recommendations for clinical practice. The results of the 2012 conference are presented as short theses and a current therapy algorithm.
转移性肾细胞癌患者的预后会危及生命。因此，治疗的目的通常是姑息治疗。然而，在过去几年中已经取得了重大进展。作为长期标准治疗的细胞因子已被新的靶向治疗所取代。舒尼替尼、贝伐单抗+干扰素-α联合用药、帕唑帕尼和替西罗莫司现已被批准用于一线治疗。舒尼替尼和帕唑帕尼也可作为二线治疗选择——帕唑帕尼仅在细胞因子治疗失败时使用。依维莫司（在酪氨酸激酶抑制剂治疗后）和索拉非尼（在细胞因子治疗后）是目前可用于二线治疗的其他药物。此外，阿昔替尼在舒尼替尼或细胞因子治疗失败后被批准用于二线治疗。关于最佳治疗顺序的问题，现在已有来自III期试验的初步研究结果。2014年召开的一次跨学科专家会议的目的是讨论哪些标准应影响治疗决策。成员们讨论了该疾病患者治疗的几个方面。2012年会议的结果为2014年会议提供了基础。与前几年一样，专家们旨在为临床实践提供共同建议。2012年会议的结果以简短论文和当前治疗算法的形式呈现。
