Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, USA.
Department of Urology, Mayo Clinic, Rochester, USA.
Ann Oncol. 2018 Feb 1;29(2):324-331. doi: 10.1093/annonc/mdx743.
The success of targeted therapies, including inhibitors of the vascular endothelial growth factor pathway or the mammalian target of rapamycin, in the treatment of metastatic renal cell carcinoma led to interest in testing their efficacy in the adjuvant setting. Results from the first trials are now available, with other studies due to report imminently. This review provides an overview of adjuvant targeted therapy in renal cell carcinoma, including interpretation of currently available conflicting data and future direction of research. We discuss the key differences between the completed targeted therapy adjuvant trials, and highlight the importance of accurately identifying patients who are likely to benefit from adjuvant treatment. We also consider reasons why blinded independent radiology review and treatment dose may prove critical for adjuvant treatment success. The implications of using disease-free survival as a surrogate end point for overall survival from the patient perspective and measurement of health benefit have recently been brought into focus and are discussed. Finally, we discuss how the ongoing adjuvant trials with targeted therapies and checkpoint inhibitors may improve our understanding and ability to prevent tumor recurrence after nephrectomy in the future.
靶向治疗的成功，包括血管内皮生长因子途径或哺乳动物雷帕霉素靶蛋白抑制剂，在转移性肾细胞癌的治疗中引起了人们对其在辅助治疗中的疗效的兴趣。现在已经有了第一批试验的结果，其他研究即将报告。这篇综述概述了肾细胞癌的辅助靶向治疗，包括对目前存在的相互矛盾的数据的解释和未来的研究方向。我们讨论了已完成的靶向治疗辅助试验之间的关键差异，并强调了准确识别可能从辅助治疗中受益的患者的重要性。我们还考虑了为什么盲法独立影像学评估和治疗剂量可能对辅助治疗的成功至关重要。从患者的角度来看，无病生存期作为总生存期替代终点的意义以及对健康获益的衡量最近引起了关注，并进行了讨论。最后，我们讨论了正在进行的靶向治疗和检查点抑制剂辅助试验如何提高我们的理解和预防肾切除术后肿瘤复发的能力。
