Current Treatment Considerations in Metastatic Renal Cell Carcinoma
Current Treatment Considerations in Metastatic Renal Cell Carcinoma
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DOI：
10.1007/s11864-012-0182-8
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发表时间：
2012-06-01
影响因子：
4.3
通讯作者：
Rini, Brian I.
中科院分区：
文献类型：
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作者：
Haddad, Housam;Rini, Brian I.
一般来说，原发肿瘤原位转移的RCC患者，如果体能状态良好，仍应考虑肾切除减积术。对于高度选择的患者，初始全身治疗应考虑高剂量IL-2。最初考虑这种疗法的一个原因是，如果在靶向治疗后使用，风险/获益特征不太确定。值得注意的是，由于其潜在的毒性和新的有效的和更耐受的药物的出现，IL-2已经成为一个不太有利的，随后在当前时代较少使用的治疗工具。否则，VEGF靶向治疗是治疗的选择，最好是在临床试验中。在试验之外，舒尼替尼长期以来一直受到青睐，但帕唑帕尼正在获得更多的耐受性，等待比较试验。考虑到RCC的潜在生物学和前瞻性临床数据，这些作者倾向于继续VEGF靶向，并指出尚未对mTOR和VEGF药物进行直接比较。维持患者剂量至关重要，需要最佳的支持性护理和毒性评估/早期干预。预测性生物标志物是迫切需要的，临床试验的招募仍然是优化患者结果的优先事项。
In general, debulking neprhectomy is still considered for metastatic RCC patients with primary tumor in place, assuming good performance status. Initial systemic therapy should consider high-dose IL-2 for the highly select patient. One reason for initial consideration of this therapy is the less certain risk/benefit profile if employed after targeted therapy. Notably, due to its potential toxicity and emergence of new effective and more tolerable drugs, IL-2 has become a less favorable and subsequently a less utilized therapeutic tool in the current era. Otherwise, VEGF-targeted therapy is the treatment of choice, preferably on a clinical trial. Off trial, sunitinib has long been favored but pazopanib is gaining more use for tolerance pending the comparative trial. Continued VEGF targeting is favored by these authors given the underlying biology of RCC and the prospective clinical data, noting no direct comparison of mTOR and VEGF agents has yet occurred. Maintaining patient dose is critical and requires optimal supportive care and appreciation/early intervention for toxicity. Predictive biomarkers are desperately needed, and enrollment on clinical trials remains a priority to optimize patient outcome.