a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA.
Expert Rev Anticancer Ther. 2018 Jul;18(7):663-671. doi: 10.1080/14737140.2018.1469980. Epub 2018 May 2.
Locally advanced, non-metastatic renal cell carcinoma (RCC) is conventionally managed with surgery. However, patients are at a high risk of RCC recurrence and have poor survival outcomes. An effective adjuvant systemic treatment is needed to improve on these outcomes. Targeted molecular and immune-based therapies have been investigated, or are under investigation, but their role in this setting remains unclear. Areas covered: A comprehensive search of PubMed and ClinicalTrials.gov was performed for relevant literature. The following topics pertinent to adjuvant therapy in RCC were evaluated: strategies for patient selection, cytokine-based immunotherapy, vaccine therapy, VEGF and non-VEGF targeted molecular agents, and immune checkpoint inhibitors. Expert commentary: Strong evidence for the incorporation of adjuvant therapy in high-risk RCC is lacking. Multiple targeted molecular therapies have been examined with only one approved for use. Genetic and molecular-based prognostic models are needed to determine who may benefit from adjuvant therapy. Developing adjuvant therapy strategies in the future depends on the results of important ongoing trials with immunotherapy and targeted agents.
局部晚期、非转移性肾细胞癌（RCC）的传统治疗方法是手术。然而，这些患者存在较高的 RCC 复发风险，生存结局较差。需要有效的辅助全身治疗来改善这些结局。已经研究了靶向分子和免疫治疗方法，或正在研究中，但它们在这种情况下的作用仍不清楚。
对 PubMed 和 ClinicalTrials.gov 进行了全面检索，以查找相关文献。评估了与 RCC 辅助治疗相关的以下主题：患者选择策略、细胞因子为基础的免疫疗法、疫苗治疗、VEGF 和非 VEGF 靶向分子药物以及免疫检查点抑制剂。
缺乏将辅助治疗纳入高危 RCC 的有力证据。已经检查了多种靶向分子疗法，但只有一种被批准使用。需要基于遗传和分子的预后模型来确定谁可能受益于辅助治疗。未来辅助治疗策略的发展取决于免疫疗法和靶向药物的重要正在进行试验的结果。
