Yekedüz Emre, Arzu Yaşar H, Utkan Güngör, Ürün Yüksel
Department of Medical Oncology, Ankara University, Ankara, Turkey.
Ankara University Cancer Research Institute, Ankara, Turkey.
J Oncol Pharm Pract. 2020 Jun;26(4):972-981. doi: 10.1177/1078155220905648. Epub 2020 Feb 25.
To define the inclusion/exclusion status of patients with brain metastasis in phase-III clinical trials and the effect of systemic therapies in metastatic renal cell cancer patients with brain metastasis.
"kidney neoplasms"[MeSH Terms] OR ("kidney"[All Fields] AND "neoplasms"[All Fields]) OR "kidney neoplasms"[All Fields] OR ("kidney"[All Fields] AND "cancer"[All Fields]) OR "kidney cancer"[All Fields] AND "brain metastasis" were used for searching "PubMed" electronic database and "clinicaltrials.gov" website.
Five of 19 landmark phase-III clinical trials included patients with stable or asymptomatic brain metastasis and there was no data about outcomes of brain metastasis. The effect of systemic therapy on prevention of brain metastasis in renal cell cancer was evaluated in four studies. Two studies showed that the incidence of brain metastasis decreased, while the other two studies showed no effect of antiangiogenic agents on the prevention of brain metastasis in patients with renal cell cancer. There were 10 trials regarding systemic therapy of renal cell cancer brain metastasis. The overall response rate improved through a combination of targeted therapies and local treatment. The results of the trials studying the effect of tyrosine kinase inhibitors without local treatment were controversial. None of the ongoing clinical trials included patients with active brain metastasis.
In metastatic renal cell cancer patients with brain metastasis, the overall response rate improved with the combination of targeted agents and local treatment. Further trials are needed to evaluate the effect of systemic treatment on the prevention or treatment of brain metastasis in patients with renal cell cancer.
确定脑转移患者在III期临床试验中的纳入/排除情况以及全身治疗对转移性肾细胞癌脑转移患者的影响。
使用“肾肿瘤”[医学主题词]或（“肾”[所有字段]与“肿瘤”[所有字段]）或“肾肿瘤”[所有字段]或（“肾”[所有字段]与“癌”[所有字段]）或“肾癌”[所有字段]以及“脑转移”检索“PubMed”电子数据库和“clinicaltrials.gov”网站。
19项具有里程碑意义的III期临床试验中有5项纳入了病情稳定或无症状的脑转移患者，且没有关于脑转移结局的数据。四项研究评估了全身治疗对肾细胞癌脑转移预防的效果。两项研究表明脑转移发生率降低，而另外两项研究表明抗血管生成药物对肾细胞癌患者脑转移的预防没有效果。有10项关于肾细胞癌脑转移全身治疗的试验。通过靶向治疗与局部治疗相结合，总体缓解率有所提高。研究未进行局部治疗的酪氨酸激酶抑制剂效果的试验结果存在争议。正在进行的临床试验中均未纳入有活动性脑转移的患者。
在有脑转移的转移性肾细胞癌患者中，靶向药物与局部治疗相结合可提高总体缓解率。需要进一步试验来评估全身治疗对肾细胞癌患者脑转移预防或治疗的效果。
