Stühler V, Kruck S, Hegemann M, Notohamiprodjo M, Todenhöfer T, Kröger N, Stenzl A, Bedke J
Klinik für Urologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72070, Tübingen, Deutschland.
Klinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
Urologe A. 2018 Mar;57(3):314-322. doi: 10.1007/s00120-017-0496-z.
Only for renal cell carcinoma (RCC) in a local stage curative treatment option by surgical resection exists. For metastatic disease the 5‑year survival rate decreases radically. A factor that contributes to this is the low sensibility to radiation and chemotherapeutics. Since the approval of the tyrosine kinase inhibitors in 2006 effective drugs for the treatment of mRCC is available. The specific inhibition of the vascular-endothelial-growth (VEGF)-receptor and the "mammalian Target of Rapamycin" (mTOR) leads to a prolongation of the progression-free survival as well as the overall survival rate. For a long time, the current target therapy with TKI appeared to be exhausted, but since recently research has gone a step further. Thus, Cabozantinib and Lenvatinib in the combination with Everolimus have been approved for second-line therapy in mRCC. For the first time a clinical study demonstrated positive results for an adjuvant treatment with sunitinib in patients with a high-risk RCC. Furthermore, in april 2016 the immune checkpoint inhibitor Nivolumab was approved for second-line therapy in mRCC in Germany. The following report examines briefly the current therapeutic recommendations, new findings and drug approvals and ongoing clinical trials.
对于局限性肾细胞癌（RCC），仅存在通过手术切除的局部阶段治愈性治疗选择。对于转移性疾病，5年生存率会急剧下降。导致这种情况的一个因素是对放疗和化疗药物的敏感性较低。自2006年酪氨酸激酶抑制剂获批以来，已有治疗转移性肾细胞癌（mRCC）的有效药物。对血管内皮生长因子（VEGF）受体和“雷帕霉素哺乳动物靶点”（mTOR）的特异性抑制可延长无进展生存期以及总生存率。长期以来，目前使用酪氨酸激酶抑制剂（TKI）的靶向治疗似乎已达到极限，但最近研究又向前迈进了一步。因此，卡博替尼和乐伐替尼与依维莫司联合已获批用于mRCC的二线治疗。一项临床研究首次证明，舒尼替尼辅助治疗高危RCC患者取得了阳性结果。此外，2016年4月，免疫检查点抑制剂纳武单抗在德国获批用于mRCC的二线治疗。以下报告简要探讨了当前的治疗建议、新发现、药物获批情况以及正在进行的临床试验。
