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Systemtherapie des Nierenzellkarzinoms

  • P. Ivanyi
  • V. GrünwaldEmail author
Leitthema
  • 23 Downloads

Zusammenfassung

Hintergrund

Die medikamentöse Behandlung des metastasierten Nierenzellkarzinoms (mRCC) hat sich in der letzten Dekade massiv verändert und wird sich weiterhin verändern.

Ziel

Im Folgenden soll ein Überblick über die gegenwärtige und zukünftige Behandlungssituation dargestellt werden.

Material und Methoden

Die Übersicht wurde unter Beachtung, Recherche und kritischer Interpretation der relevanten Phase-II- und -III-Studien (PubMed) sowie aktueller Kongressbeiträge (American Society of Clinical Oncology [ASCO], European Society of Medical Oncology [ESMO]) als auch der gegenwärtigen Leitlinien (S3, ESMO, National Comprehensive Cancer Network [NCCN]) erstellt.

Ergebnisse und Diskussion

Die gegenwärtige Behandlungssituation des mRCC befindet sich in massivem Wandel. Eine Risikostratifizierung nach IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) oder MSKCC (Memorial Sloan Kettering Cancer Center) ist zunehmend relevant für den klinischen Alltag. Gegenwärtig bleibt unter den medikamentösen Therapieoptionen die Inhibition des VEGFR (vaskulärer endothelialer Wachstumsfaktor-Rezeptor) die Standardoption für Patienten mit günstiger Prognose, die im Einzelfall auch für die intermediäre Gruppe eine Option darstellt. Die optimale Therapie für Patienten mit intermediärer und schlechter Prognose stellt die immunonkologische Doublettentherapie aus CTLA-4- und PD-1-Inhibition dar (PD-1 „programmed death receptor 1“, CTLA-4 „cytotoxic T‑lymphocyte associated protein 4“). Absehbar wird die Kombinationstherapie aus PD-1-Inhibition und VEGFR-Inhibition die Therapiemöglichkeiten im Alltag erweitern.

Schlüsselwörter

Immunonkologische Doublettentherapie PD-1-Inhibition Medikamentöse Therapie VEGFR-Inhibition Immuncheckpointinhibition 

Systemic treatment of renal cell carcinoma

Abstract

Background

The pharmacological treatment of metastatic renal cell carcinoma (mRCC) has massively changed over the last decade and will continue to change in the future.

Objective

This article gives an overview of the current and future treatment situation.

Material and methods

This overview is based on the research and critical interpretation of the relevant phase II and phase III studies (PubMed), currently available congress articles, e.g. the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO) and current guidelines, e.g. S3, ESMO and the National Comprehensive Cancer Network (NCCN).

Results and discussion

The current treatment situation for mRCC is in a state of massive flux. A risk stratification according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) or Memorial Sloan Kettering Cancer Center (MSKCC) model is becoming increasingly more relevant for the clinical routine. Currently, of the pharmacological treatment options vascular endothelial growth factor receptor (VEGFR) inhibition remains the standard option for patients with a favorable prognosis, which also represents an option for the intermediate group in individual cases. The optimal treatment for patients with intermediate and poor prognoses is immuno-oncological doublet treatment with CTLA-4 and PD-1. In the foreseeable future the combination treatment of PD-1 inhibition and VEGFR inhibition will extend the treatment options in the daily routine.

Keywords

Immuno-oncological doublet treatment  PD-1 inhibition Drug treatment VEGFR inhibition Checkpoint inhibition 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Ivanyi: Beratung oder Gutachten: BMS, Bayer, EISAI, Ipsen, Merck, Novartis, Pfizer. Vortragshonorare: AIM, AstaZeneca, BMS, Bayer, EISAI, EUSA, Ipsen, Merck, MedKomAkademie, Novartis, Pfizer, Roche StreamedUP!. Forschungsförderung: BMS, Bayer, Lilly, Merck, Novartis, EISAI, Pfizer, MSD, AstraZeneca, Roche, Ipsen. Andere Finanzielle Beziehungen (Reisekostenzuschuss): BMS, Novartis, Merck, Ipsen, Bayer. Nichtfinanzielle Interessenkonflikte (Forschungsinteressen): mRCC, R/M-HNSCC, STS, PD-1, PDL1, PD-L2, cMET, Piwi-like, IO, PMSA, BAP1, NLR, CRP. V. Grünwald: Vortrags- und Beratungshonorare: Art tempi, AstraZeneca, Astellas, BMS, Cerulean, COCS, ClinSol, EUSAPharm, EISAI, lpsen, MedUpdate, Merck Serono, MSD Merck, MedKomAkademie, Novartis, NewConceptOncology, Lilly, Johnson & Johnson, PharmaMar, PeerVoice, Rache, StreamedUp!, ThinkWired!. Förderung: BMS, Novartis, EISAI, Pfizer, MSD, AstraZeneca, Rache, lpsen. Aktien- und Anteilsbesitz: AstraZeneca, BMS, MSD.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Hämatologie, Hämostaseologie, Onkologie und StammzelltransplantationMedizinische Hochschule HannoverHannoverDeutschland
  2. 2.Innere Klinik (Tumorforschung) und Klinik für Urologie, Schwerpunkt interdisziplinäre Uroonkologie, Westdeutsches TumorzentrumUniversitätsklinikum Essen (AöR)EssenDeutschland

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