Chemotherapy in metastatic renal cell carcinoma today? A systematic review
Chemotherapy in metastatic renal cell carcinoma today? A systematic review
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DOI：
10.1097/cad.0b013e3283609ec1
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发表时间：
2013-07-01
影响因子：
2.3
通讯作者：
Massari, Francesco
中科院分区：
文献类型：
--
作者：
Buti, Sebastiano;Bersanelli, Melissa;Massari, Francesco
受转移性肾细胞癌（mRCC）影响的患者的预后通过靶向治疗显著改善。不幸的是，20-25%的患者在首次缓解评估时对治疗难治，并且大多数患者将在治疗期间获得耐药性。此外，由于缺乏前瞻性试验，目前关于靶向药物在低风险或非透明细胞mRCC患者中的临床活性的数据是不确定的。因此，仍有一些患者需要新的治疗方法来改善临床结局。肾癌在历史上被认为对化疗具有抗性，因为II期试验的结果并不总是有希望的。我们对单药化疗和多药化疗单独或联合免疫治疗或靶向药物治疗mRCC进行了系统评价，以确定最新技术水平并评估进一步的临床研究领域。对2003年1月至2012年11月在文献中发表的至少入组20例患者的所有回顾性、I期/剂量探索、II期和III期mRCC化疗研究进行了评价。尽管临床试验的结果往往令人失望，但在选定的mRCC病例中，化疗可能具有有希望的抗肿瘤活性，特别是当存在肉瘤样分化特征时，或在高度进展的疾病中，阿霉素加吉西他滨或卡培他滨的联合治疗产生了有趣的结果。化疗可能在mRCC中发挥作用，而靶向药物和免疫治疗尚未产生持久和令人满意的结果;需要进一步研究。(c)2013年威科健康垂直酒吧利平科特威廉姆斯&威尔金斯。
The prognosis of patients affected by metastatic renal cell carcinoma (mRCC) has improved markedly with targeted therapies. Unfortunately, 20-25% of the patients are refractory to treatment at the first response assessment and most patients will acquire drug resistance during the treatment. Moreover, current data on the clinical activity of targeted agents in poor risk or non-clear-cell mRCC patients are inconclusive because of the absence of prospective trials. Therefore, there are still several patients in need of new therapeutic approaches to improve clinical outcomes. Kidney cancer is historically considered resistant to chemotherapy on the basis that the results of phase II trials have not always been promising. We carried out a systematic review of both monochemotherapy and polychemotherapy alone or combined with immunotherapy or targeted agents in mRCC to define the state of the art and to evaluate further clinical research fields. All retrospectives, phase I/dose finding, phase II and phase III studies on chemotherapy in mRCC, published in the literature from January 2003 to November 2012, with at least 20 patients enrolled, were evaluated. Although the results of clinical trials have often been disappointing, in selected cases of mRCC, chemotherapy may have a promising antitumor activity, particularly when there are sarcomatoid differentiation features, or in highly progressive disease where the combination of doxorubicine plus gemcitabine or capecitabine has yielded interesting results. Chemotherapy may play a role in mRCC, whereas targeted agents and immunotherapy have not yielded durable and satisfactory results; further studies are needed. (c) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.