Division of Experimental Oncology, Department of Urology, URI - Urological Research Institute.
Division of Experimental Oncology, Department of Clinical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
Curr Opin Urol. 2022 Jan 1;32(1):31-39. doi: 10.1097/MOU.0000000000000950.
While the molecular and genetic bases of Von Hippel-Lindau (VHL) disease have been extensively investigated, limited evidence is available to guide diagnosis, local or systemic therapy, and follow-up. The aim of the current review is to summarize the ongoing trials both in preclinical and clinical setting regarding VHL disease management.
Although genotype/phenotype correlations have been described, there is considerable inter and intra-familiar heterogeneity in VHL disease. Genetic anticipation has been reported in VHL disease. From a clinical point of view, expert-opinion-based protocols suggest testing those patients with any blood relative of an individual diagnosed with VHL disease, those with at least 1 or more suggestive neoplasms or patients presenting with clear cell renal cell carcinoma (ccRCC) diagnosed at a less than 40 years old, and/or multiple ccRCC. Clinical research is focused on safety and efficacy of systemic agents for patients with VHL-related ccRCC, with the aim to possibly preserve kidney function and improve patient survival.
To date, preclinical and clinical research on the topic is scarce and clinical guidelines are not supported by strong validation studies.
综述目的:尽管已对 von Hippel-Lindau(VHL) 病的分子和遗传基础进行了广泛研究,但目前仅有有限的证据可用于指导诊断、局部或全身治疗以及随访。本综述的目的是总结目前关于 VHL 疾病管理的临床前和临床研究中的试验。
最新发现:尽管已描述了基因型/表型相关性,但 VHL 疾病存在很大的个体内和家族内异质性。已报道 VHL 疾病存在遗传早现。从临床角度来看,基于专家意见的方案建议对以下患者进行检测:有任何一位确诊为 VHL 病的血缘亲属的患者、至少有 1 种或更多提示性肿瘤的患者、40 岁以下确诊为透明细胞肾细胞癌(ccRCC)的患者,和/或有多个 ccRCC 的患者。临床研究的重点是 VHL 相关性 ccRCC 患者的全身药物的安全性和有效性,目的是可能保留肾功能并提高患者生存率。
总结:迄今为止,关于该主题的临床前和临床研究很少,且临床指南没有得到强有力的验证研究的支持。