European association of urology guidelines for systemic therapy in metastatic renal cell carcinoma: What is recommended and why?
European association of urology guidelines for systemic therapy in metastatic renal cell carcinoma: What is recommended and why?
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DOI：
10.1016/j.eursup.2007.12.002
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发表时间：
2008-02-01
影响因子：
--
通讯作者：
Patard, Jean-Jacques
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作者：
Patard, Jean-Jacques
转移性肾细胞癌（mRCC）在很大程度上对常规化疗、激素治疗和细胞因子治疗具有抗性，并且与不良预后相关。欧洲泌尿外科协会（EAU）最近发布了更新的指南，对治疗mRCC提出了具体建议。EAU的建议是基于最近的临床研究数据，这些数据证明了新的靶向治疗优于干扰素-α（IFN-α）。mRCC是一种高度血管化的肿瘤，在大多数情况下，其特征在于过度产生血管生成肽，如血管内皮生长因子。靶向治疗选择性地抑制其功能包括刺激血管生成的蛋白质;其中两种疗法，舒尼替尼和索拉非尼，目前在欧盟被批准用于mRCC。更新的EAU指南反映了现有的改进选择，建议使用舒尼替尼，一种口服抗血管生成药物，选择性靶向几种受体，其配体在RCC中上调，作为良好和中等风险患者mRCC的一线治疗。这一建议是基于一项3期试验的令人信服的数据，该试验表明，接受舒尼替尼治疗的未经治疗的mRCC患者的无进展生存期较长，客观缓解率高于接受IFN-α治疗的患者。其他建议包括使用索拉非尼作为mRCC的二线治疗，并考虑将替西罗莫司作为mRCC低风险患者的一线治疗。这些药物单独或联合使用的临床研究正在进行中。我们回顾了构成EAU指南基础的临床研究，以深入了解更新建议背后的基本原理。(c)2007年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Metastatic renal cell carcinoma (mRCC) is largely resistant to conventional chemotherapy, hormonal therapy, and cytokine therapy and is associated with a poor prognosis. The European Association of Urology (EAU) recently published updated guidelines, with specific recommendations for treating mRCC. The EAU recommendations were based on recent clinical study data, which demonstrated the superiority of newer targeted therapies over interferon-alpha (IFN-alpha). mRCC is a highly vascularised tumour, characterised in the majority of cases by over-production of angiogenic peptides such as vascular endothelial growth factor. The targeted therapies selectively inhibit proteins whose functions include the stimulation of angiogenesis; two of these therapies, sunitinib and sorafenib, are currently approved in the European Union for use in mRCC. Reflecting the improved options now available, the updated EAU guidelines recommend using sunitinib, an orally administered antiangiogenic drug that selectively targets several receptors whose ligands are up-regulated in RCC, as first-line therapy for mRCC in good- and intermediate-risk patients. This recommendation is based on compelling data from a phase 3 trial that demonstrated longer progression- free survival and greater objective response rates for untreated patients with mRCC receiving sunitinib than for those receiving IFN-alpha. Other recommendations include using sorafenib as second-line therapy for mRCC and considering temsirolimus as first-line therapy for poor-risk patients with mRCC. Clinical studies investigating these agents, both alone and in combination, are ongoing. We review the clinical studies that form the basis of the EAU guidelines to gain an insight into the rationale behind the updated recommendations. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.