Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
Curr Cancer Drug Targets. 2018;18(5):468-479. doi: 10.2174/1568009617666170209094030.
In the last decades, the treatment of mRCC, metastatic Renal Cell Carcinoma, has become more and more complex due to the approval of a great number of effective systemic treatments that have significantly improved the prognosis of patients suffering from such disease. An additional knowledge of the genetic aberrations and the molecular pathways alterations that underlie RCC, has promoted the development of several novel agents, known as target therapies (TTs). Even though TTs are not curative and all patients eventually progress, an adequate sequencing of these drugs can provide a significant benefit in terms of PFS, Progression Free Survival, and hopefully OS, Overall Survival. To date, there are few data about the optimal sequential use of the TTs hence, in clinical practice, the therapeutic strategy is chosen on the basis of the safety profile of the drug, patients medical history and the pivotal trial results, though such studies often exclude patients with poor performance status and/or severe comorbidities that we routinely see in our clinics. This review aims to provide an overview of the systemic therapies for mRCC both in the newly diagnosed patients and in the subsequent lines of treatment, with a special focus on the last advances about TTs and immunotherapy.
在过去的几十年中，由于大量有效的全身治疗方法的批准，转移性肾细胞癌（mRCC）的治疗变得越来越复杂，这些方法显著改善了患有这种疾病的患者的预后。对导致 RCC 的遗传异常和分子途径改变的进一步了解，促进了几种新型药物的开发，这些药物被称为靶向治疗（TTs）。尽管 TTs 不能治愈，所有患者最终都会进展，但这些药物的适当序贯使用可以在无进展生存期（PFS）和总生存期（OS）方面带来显著获益。迄今为止，关于 TTs 的最佳序贯使用的相关数据很少，因此，在临床实践中，治疗策略是基于药物的安全性、患者的病史和关键试验结果来选择的，尽管这些研究经常排除我们在临床实践中经常遇到的身体状况不佳和/或合并症严重的患者。本综述旨在概述 mRCC 的系统治疗方法，包括新诊断患者和后续治疗线，特别关注 TTs 和免疫治疗的最新进展。
