| 718 | 8 | 16 |
| 下载次数 | 被引频次 | 阅读次数 |
近年来,随着人们对肾细胞癌发病机制研究的不断深入,产生了抗VEGF受体抑制剂和mTOR抑制剂,使得转移性肾细胞癌进入靶向治疗时代。本文对国内外最新研究结果进行分析,对于转移性肾细胞癌患者,靶向药物首选舒尼替尼和培唑帕尼,药物剂量从标准剂量开始,疾病进展时,可酌情增量;出现不良反应时,应及时对症处理或减量。使用抗VEGF抑制剂时,应密切监测患者血压,当患者血糖较高或患有糖尿病时,应首选抗VEGF抑制剂。
Abstract:In recent years, with the deepening of research on the pathogenesis of renal cell carcinoma, anti-VEGF receptor inhibitors and mTOR inhibitors have been produced, making metastatic renal cell carCInoma into the era of targeted therapy. This article analyzed the latest research results at home and abroad. For patients with metastatic renal cell carcinoma, sunitinib and pizopanib are the first choice for targeted drugs. The drug dose starts from the standard dose, and the disease can be increased as appropriate when the disease progresses; When responding, it should be treated or reduced in time. When using an anti-VEGF inhibitor, the patient's blood pressure should be closely monitored. When the patient has high blood sugar or diabetes, anti-VEGF inhibitors should be preferred.
1 SiegelRL,Miller KD,Jemal A.Cancer statistics,2019[J].CA A Cancer J Clin,2019,69(1):7-34.
2 叶定伟,张海梁.中国肾癌诊治现状和发展趋势[J].中华泌尿外科杂志,2014,35(6):401-405.
3 魏先,柯鑫文,胡志全,等.舒尼替尼治疗晚期肾癌的临床疗效及安全性分析[J].现代泌尿生殖肿瘤杂志,2017,9(3):133-136.
4 Toni K.Choueiri.Robert J.Systemic therapy for metastatic renal-cell carcinoma[J].N Engl J Med,2017,376(4):354-366.
5 Kaelin WG Jr.The von hippel-lindautumour suppressor protein:O2 sensing and cancer[J].Nat Rev Cancer,2008,8(11):865-873.
6 National comprehensive cancer network.NCCN clinical practice guidelines in oncology:kidney cancer,version 3.2019.
7 Sabatini DM.mTOR and cancer:insights into a complex relationship[J].Nat Rev Cancer,2006,6(9):729-734.
8 Kwiatkowski DJ,Manning BD.Molecular basis of giant cells in tuberous sclerosis complex[J].N Engl J Med,2014,371(8):778-780.
9 Motzer RJ,Hutson TE,Tomczak P,et al.Sunitinib versus interferon Alfa in metastatic renal-cell carcinoma[J].N Engl J Med,2007,356(2):115-124.
10 Motzer RJ,Hutson TE,Tomczak P,et al.Overall survival and updated results for sunitinib compared with interferon Alfa in patients with metastatic renal cell carcinoma[J].J Clin Oncol,2009,27(22):3584-3590.
11 孙泽威.舒尼替尼治疗转移性肾癌131例临床分析[D].杭州:浙江大学,2016.
12 魏先,柯鑫文,胡志全,等.舒尼替尼治疗晚期肾癌的临床疗效及安全性分析[J].现代泌尿生殖肿瘤杂志,2017,9(3):133-136.
13 陈雪,刘开泰,贝宴屏,等.舒尼替尼治疗46例转移性肾癌的预后因素分析[J].中国现代医生,2017,55(25):11-14.
14 席栋梁,李黎明.索拉菲尼靶向治疗转移性肾癌的有效性及安全性[D].天津:天津医科大学研究生院.2018,5.
15 秦军,武国军,王福利,等.索拉非尼治疗转移性肾癌的临床疗效与安全性[J].现代泌尿外科杂志,2018,23(12):928-932.
16 李永强,李汉忠,邓建华,等.索拉非尼治疗进展性肾癌长期存活因素的探讨[J].临床泌尿外科杂志,2015,30(7):607-609.
17 王振,王施广,董永超,等.索拉非尼治疗晚期肾癌患者的总体生存期分析[J].现代泌尿外科杂志,2015,20(9):628-631.
18 Motzer RJ,Hutson TE,Cella D,et al.Pazopanib versus sunitinib in metastatic renal-cell carcinoma[J].NEngl J Med,2013,369(8):722-731.
19 Sternberg CN,Davis ID,Mardiak J,et al.Pazopanib in locally advanced or metastatic renal cell carcinoma:results of a randomized phase Ⅲ trial[J].J Clin Oncol,2010,28(6):1061-1068.
20 Sternberg CN,Hawkins RE,Wagstaff J,et al.A randomised,double-blind phase Ⅲ study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma:final overall survival results and safety update[J].Eur J Cancer,2013,49(6):1287-1296.
21 Taneja SS.Re:Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS):a randomised phase 3 trial[J].J Urol,2012,188(2):412-413.
22 Trask PC,Bushmakin AG,Cappelleri JC,et al.Baseline patient-reported kidney cancer-specific symptoms as an indicator for Median survival in sorafenib-refractory metastatic renal cell carcinoma[J].J Cancer Surviv,2011,5(3):255-262.
23 Motzer RJ,Escudier B,Oudard S,et al.Efficacy of everolimus in advanced renal cell carcinoma:a double-blind,randomised,placebo-controlled phase Ⅲ trial[J].Lancet,2008,372(9637):449-456.
24 Choueiri TK,Halabi S,Sanford BL,et al.Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk:the alliance A031203 CABOSUN trial[J].J Clin Oncol,2017,35(6):591-597.
25 Choueiri TK,Hessel C,Halabi S,et al.Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial):Progression-free survival by independent review and overall survival update[J].Eur J Cancer,2018,94:115-125.
26 George DJ,Hessel C,Halabi S,et al.Cabozantinib versus sunitinib for previously untreated patients with advanced renal cell carcinoma (RCC) of intermediate or poor risk:Subgroup analysis of progression-free survival (PFS) and objective response rate (ORR) in the Alliance A031203 CABOSUN trial[J].J Clin Oncol,2018,36(6_suppl):582.
27 Wallis CJD,KlaassenZ,BhindiB,et al.First-line systemic therapy for metastatic renal cell carcinoma:A systematic review and network meta-analysis[J].Eur Urol,2018,74(3):309-321.
28 Motzer RJ,Tannir NM,McDermott DF,et al.Nivolumab plus ipilimumab26 versus sunitinib in advanced renal-cell carcinoma[J].N Engl J Med ,George 2018,378 (14)DJ:1277-1290.
29 National comprehensive cancer network.NCCN clinical practice guidelines in oncology:kidney cancer,version 2.2017.
30 Armstrong AJ,Halabi S,Eisen T.et al.Everolimus versus sunitinib for patients with metastatic non-clear cell renal cell carcinoma (ASPEN):a multicentre,open label,randomised phase 2 trial[J].Lancet Oncol,2016,17:378-88.
31 Tannir NM,Jonasch E,Albiges L,et al.Everolimus versus sunitinib prospective evaluation in metastatic non-clear cell renal cell carcinoma (ESPN):A randomized multicenter phase 2 trial[J].Eur Urol,2016,69(5):866-874.
32 Ravaud A,Barrios CH,Alekseev B,et al.RECORD-2:phaseIIrandomizedstudy ofeverolimus and bevacizumab versus interferon α-2a and bevacizumab as first-line therapy in patients with metastatic renal cell carcinoma[J].Ann Oncol,2015,26(7):1378-1384.
33 Motzer RJ,Hutson TE,Ren M.et al.Independent assessment of lenvatinib plus everolimus in patients with metastatic renal cell carcinoma[J].Lancet Oncol 2016,17(1):e4-e5.
34 Hudes G,Carducci M,Tomczak P,et al.Temsirolimus,interferon Alfa,or both for advanced renal-cell carcinoma[J].N Engl J Med,2007,356(22):2271-2281.
35 Heng DY,XieWL,Regan MM,et al.Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents:results from a large,multicenter study[J].J Clin Oncol,2009,27(34):5794-5799.
基本信息:
DOI:10.13210/j.cnki.jhmu.20190904.002
中图分类号:R737.11
引用信息:
[1]王雨生,双卫兵.转移性肾细胞癌靶向治疗进展[J].海南医学院学报,2019,25(19):1512-1515+1520.DOI:10.13210/j.cnki.jhmu.20190904.002.
基金信息:
国家自然科学基金资助项目(81572207)~~
2019-09-05
2019-09-05
2019-09-05