Miller Kurt, Bergmann Lothar, Doehn Christian, Grünwald Viktor, Gschwend Jürgen E, Ivanyi Philipp, Keilholz Ulrich, Kuczyk Markus A
Charité - Universitätsmedizin Berlin, Urologie, Berlin.
Ambulantes Krebszentrum Schaubstraße (AKS), Frankfurt.
Aktuelle Urol. 2020 Dec;51(6):572-581. doi: 10.1055/a-1252-1780. Epub 2020 Oct 7.
Due to novel therapies, the prognosis of patients with metastatic renal cell carcinoma (mRCC) has improved. A median overall survival of more than two years is a realistic goal. Immunotherapy combinations with checkpoint inhibitors or checkpoint inhibitors and the tyrosine kinase inhibitor axitinib are new first-line options.Sunitinib, pazopanib, tivozanib and the combination of bevacizumab + interferon alpha are approved for first-line therapy regardless of the progression risk score. The use of both the combination of nivolumab + ipilimumab and cabozantinib is restricted to intermediate and high-risk patients. In this subgroup, the immunotherapy combination was more effective in terms of overall survival compared with sunitinib. Temsirolimus is only approved for high-risk patients.Sunitinib and pazopanib can also be applied as second-line options - for pazopanib the use is restricted to the event of cytokine failure. Nivolumab and cabozantinib demonstrated superior overall survival compared with everolimus. Furthermore, the combination of lenvatinib + everolimus and axitinib are approved treatment options in the second-line and further settings. Everolimus has been replaced in the second-line setting by these new options.The question regarding the optimal sequence is still unanswered.The purpose of an interdisciplinary expert meeting was to debate which criteria should influence treatment. The members discussed several aspects of treating patients with advanced or metastatic RCC. As in previous years, the experts intended to provide recommendations for clinical practice. The results are presented in this publication.
由于新型疗法的出现，转移性肾细胞癌（mRCC）患者的预后得到了改善。超过两年的中位总生存期是一个现实的目标。免疫疗法与检查点抑制剂联合使用，或检查点抑制剂与酪氨酸激酶抑制剂阿昔替尼联合使用，是新的一线治疗选择。无论疾病进展风险评分如何，舒尼替尼、帕唑帕尼、替沃扎尼以及贝伐单抗+干扰素α联合方案均被批准用于一线治疗。纳武单抗+伊匹单抗联合方案以及卡博替尼仅适用于中高危患者。在这一亚组中，与舒尼替尼相比，免疫疗法联合方案在总生存期方面更有效。替西罗莫司仅被批准用于高危患者。舒尼替尼和帕唑帕尼也可作为二线治疗选择——帕唑帕尼仅在细胞因子治疗失败的情况下使用。与依维莫司相比，纳武单抗和卡博替尼显示出更好的总生存期。此外，乐伐替尼+依维莫司联合方案以及阿昔替尼是二线及后续治疗的批准方案。在二线治疗中，依维莫司已被这些新方案所取代。关于最佳治疗顺序的问题仍未得到解答。一次跨学科专家会议的目的是讨论哪些标准应影响治疗。成员们讨论了晚期或转移性RCC患者治疗的几个方面。与前几年一样，专家们旨在为临床实践提供建议。结果在本出版物中呈现。
