Argentiero Antonella, Solimando Antonio Giovanni, Krebs Markus, Leone Patrizia, Susca Nicola, Brunetti Oronzo, Racanelli Vito, Vacca Angelo, Silvestris Nicola
Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, 70124 Bari, Italy.
Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli', University of Bari Medical School, 70124 Bari, Italy.
J Clin Med. 2020 May 24;9(5):1594. doi: 10.3390/jcm9051594.
Although decision making strategy based on clinico-histopathological criteria is well established, renal cell carcinoma (RCC) represents a spectrum of biological ecosystems characterized by distinct genetic and molecular alterations, diverse clinical courses and potential specific therapeutic vulnerabilities. Given the plethora of drugs available, the subtype-tailored treatment to RCC subtype holds the potential to improve patient outcome, shrinking treatment-related morbidity and cost. The emerging knowledge of the molecular taxonomy of RCC is evolving, whilst the antiangiogenic and immunotherapy landscape maintains and reinforces their potential. Although several prognostic factors of survival in patients with RCC have been described, no reliable predictive biomarkers of treatment individual sensitivity or resistance have been identified. In this review, we summarize the available evidence able to prompt more precise and individualized patient selection in well-designed clinical trials, covering the unmet need of medical choices in the era of next-generation anti-angiogenesis and immunotherapy.
尽管基于临床组织病理学标准的决策策略已经确立，但肾细胞癌（RCC）代表了一系列生物生态系统，其特征是具有独特的基因和分子改变、多样的临床病程以及潜在的特定治疗弱点。鉴于有大量药物可供使用，针对RCC亚型的亚型特异性治疗有可能改善患者预后，减少治疗相关的发病率和成本。RCC分子分类学的新知识正在不断发展，而抗血管生成和免疫治疗领域则保持并强化了它们的潜力。尽管已经描述了RCC患者的几个生存预后因素，但尚未确定治疗个体敏感性或耐药性的可靠预测生物标志物。在本综述中，我们总结了现有证据，这些证据能够在精心设计的临床试验中促使更精确和个性化的患者选择，满足下一代抗血管生成和免疫治疗时代医疗选择的未满足需求。
