Noronha V, Joshi A, Bakshi G, Tongaonkar H, Prabhash K
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2016 Jan-Mar;53(1):102-8. doi: 10.4103/0019-509X.180824.
The development of targeted agents has expanded the anticancer arsenal available to oncologists and revolutionized the field of cancer treatment. In patients with advanced renal cell carcinoma (RCC), small molecule targeted therapies have improved clinical outcomes compared with cytokine-based treatments. Sunitinib malate is one such drug that has demonstrated clinical efficacy in patients with metastatic renal cell carcinoma (mRCC). This oral, multi-targeted tyrosine kinase inhibitor is approved for use in multiple countries for the treatment of advanced RCC and gastrointestinal stromal tumor patients who have progressed on imatinib therapy. In patients with advanced RCC, sunitinib significantly improves clinical outcomes with a favorable safety profile compared with conventional treatment with interferon-a. The clinically proven treatment and safety outcomes have led investigators to evaluate the merits of sunitinib therapy in the adjuvant and neoadjuvant setting in patients with mRCC. In the neoadjuvant setting, preliminary data suggest that sunitinib can effectively reduce the primary tumor and facilitate surgical resection in patients with locally advanced and mRCC. Post-operative complications were observed in some patients, but the overall safety profile and efficacy suggests that mRCC patients with surgically inoperable tumors may benefit from neoadjuvant sunitinib therapy. Ongoing clinical trials should provide insight into the value of sunitinib as adjuvant therapy.
靶向药物的发展扩大了肿瘤学家可用的抗癌武器库，并彻底改变了癌症治疗领域。在晚期肾细胞癌（RCC）患者中，与基于细胞因子的治疗相比，小分子靶向治疗改善了临床结局。苹果酸舒尼替尼就是这样一种药物，已在转移性肾细胞癌（mRCC）患者中显示出临床疗效。这种口服的多靶点酪氨酸激酶抑制剂已在多个国家获批用于治疗晚期RCC以及对伊马替尼治疗进展的胃肠道间质瘤患者。在晚期RCC患者中，与使用干扰素-α的传统治疗相比，舒尼替尼显著改善了临床结局且安全性良好。临床验证的治疗和安全性结果促使研究人员评估舒尼替尼在mRCC患者辅助和新辅助治疗中的价值。在新辅助治疗中，初步数据表明舒尼替尼可有效缩小原发性肿瘤，并便于局部晚期和mRCC患者进行手术切除。部分患者观察到术后并发症，但总体安全性和疗效表明，患有手术无法切除肿瘤的mRCC患者可能受益于新辅助舒尼替尼治疗。正在进行的临床试验应能深入了解舒尼替尼作为辅助治疗的价值。
