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Medikamentöse Therapie des metastasierten Nierenzellkarzinoms

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Die Urologie

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Zusammenfassung

Das metastasierte Nierenzellkarzinom (mRCC) ist die häufigste metastasierte von Parenchymtumoren der Niere ausgehende Erkrankung und tritt zu 10–20 % nach initial kurativer Behandlung auf. Die weitere Erforschung der Pathomechanismen führte zur Entwicklung zielgerichteter Medikamente wie den Tyrosinkinase-Inhibitoren (TKI), Inhibitoren des mammalian Target of Rapamycin (mTOR) und den Checkpoint-Inhibitoren zur Behandlung der fortgeschrittenen metastasierten Erkrankung. Die Substanzen aus der Gruppe der zielgerichteten Therapeutika stehen inzwischen zur Therapie des fortgeschrittenen Nierenzellkarzinoms zur Verfügung und werden in diesem Kapitel dargestellt und diskutiert. Nachdem TKI über mehr als ein Jahrzehnt die systemische Therapie dominiert haben, erfolgte jüngst ein Paradigmewechsel hin zur Immuntherapie und Immuntherapiekombinationen mit den sogenannten Checkpoint-Inhibitoren (CPI) (Kroger N, Merseburger AS, Bedke J, Aktuelle Urol 50(6):606–611, 2019). Für die Erstlinientherapie des mRCC sind Ipilimumab + Nivolumab (intermediäres und hohes Risiko) und Pembrolizumab + Axitinib sowie Avelumab + Axitinib für alle Risikogruppen zugelassen. Darüber hinaus stehen Sunitinib, Pazopanib, Tivozanib, Cabozantinib (intermediäres und hohes Risiko), die Kombination Bevacizumab + Interferon-alpha sowie Temsirolimus (hohes Risiko) zur Verfügung. Für Nivolumab und Cabozantinib wurde in der Zweitlinientherapie ein signifikanter Überlebensvorteil gegenüber Everolimus gezeigt. Die Kombination Lenvatinib + Everolimus sowie Axitinib sind weitere für die Zweitlinie zugelassene Substanzen.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    Axel S. Merseburger

  2. Schwerpunkt interdisziplinäre Uroonkologie, Universitätsklinikum Essen (AöR), Essen, Deutschland

    Viktor Grünwald

Authors
  1. Axel S. Merseburger
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  2. Viktor Grünwald
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Corresponding author

Correspondence to Axel S. Merseburger .

Editor information

Editors and Affiliations

  1. Klinik für Urologie, Universitätsmedizin Mannheim, Mannheim, Baden-Württemberg, Deutschland

    Maurice Stephan Michel

  2. Klinik für Urologie, Universitätsklinikum Mainz, Mainz, Deutschland

    Joachim W. Thüroff

  3. Abt. für Urologie, Universitätsklinikum Salzburg, Salzburg, Salzburg, Österreich

    Günther Janetschek

  4. Klinik und Poliklinik für Urologie, Univer Tech Univ Dresden, Dresden, Sachsen, Deutschland

    Manfred P. Wirth

Section Editor information

  1. Klinik für Urologie, Universitätsklinikum Salzburg, Salzburg, Österreich

    Günter Janetschek

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Merseburger, A.S., Grünwald, V. (2022). Medikamentöse Therapie des metastasierten Nierenzellkarzinoms. In: Michel, M.S., Thüroff, J.W., Janetschek, G., Wirth, M.P. (eds) Die Urologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41168-7_60-2

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  • DOI: https://doi.org/10.1007/978-3-642-41168-7_60-2

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  • Print ISBN: 978-3-642-41168-7

  • Online ISBN: 978-3-642-41168-7

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Chapter history

  1. Latest

    Medikamentöse Therapie des metastasierten Nierenzellkarzinoms
    Published:
    06 April 2022

    DOI: https://doi.org/10.1007/978-3-642-41168-7_60-2

  2. Original

    Medikamentöse Therapie des metastasierten Nierenzellkarzinoms
    Published:
    13 February 2015

    DOI: https://doi.org/10.1007/978-3-642-41168-7_60-1

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