Bindayi Ahmet, Hamilton Zachary A, McDonald Michelle L, Yim Kendrick, Millard Frederick, McKay Rana R, Campbell Steven C, Rini Brian I, Derweesh Ithaar H
Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA.
Department of Internal Medicine, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA.
Urol Oncol. 2018 Jan;36(1):31-37. doi: 10.1016/j.urolonc.2017.07.015. Epub 2017 Aug 10.
Neoadjuvant Targeted Molecular Therapy in the setting of localized and locally advanced renal cell carcinoma has emerged as a strategy to render primary renal tumors amenable to planned surgical resection in settings where radical resection or nephron-sparing surgery was not thought to be safe or feasible. Presurgical tumor reduction has been demonstrated in a number of studies including a recently published randomized double-blind placebo-controlled study, and an expanding body of literature suggests benefit in select patients. Nonetheless, most reports are small phase II clinical trials or retrospective reports. Thus, large randomized clinical trial data are not present to support this approach, and guidelines for use of presurgical therapy have not been promulgated. The advent of immunomodulation through checkpoint inhibition represents an exciting horizon for neoadjuvant strategies. This article reviews the current status and future prospects of neoadjuvant therapy in nonmetastatic renal cell carcinoma.
在局限性和局部进展性肾细胞癌的背景下，新辅助靶向分子治疗已成为一种策略，旨在使原发性肾肿瘤在根治性切除或保留肾单位手术被认为不安全或不可行的情况下能够接受计划性手术切除。包括最近发表的一项随机双盲安慰剂对照研究在内的多项研究已证明术前肿瘤缩小，并且越来越多的文献表明对特定患者有益。尽管如此，大多数报告都是小型II期临床试验或回顾性报告。因此，目前尚无大型随机临床试验数据支持这种方法，并且尚未颁布术前治疗的使用指南。通过检查点抑制进行免疫调节的出现为新辅助策略带来了令人兴奋的前景。本文综述了非转移性肾细胞癌新辅助治疗的现状和未来前景。
