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Systemische Therapie des metastasierten Nierenzellkarzinoms

Systemic therapy of metastatic renal cell carcinoma

  • Leitthema
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Zusammenfassung

Zur systemischen Therapie des metastasierten, chirurgisch nicht weiter resektablen Nierenzellkarzinoms stand bislang lediglich die Therapie mit Zytokinen zur Verfügung. Die Immuntherapie hatte sich in den letzten 15 Jahren zur Behandlung von Patienten mit metastasiertem Nierenzellkarzinom (mNZK) zunehmend etabliert. Die Zytokine Interleukin-2 (IL-2) und Interferon-α (IFN-α) haben hierbei als Einzelsubstanzen die größten Effekte für die Therapie von Patienten mit mNZK gezeigt. Die subkutanen Applikationsformen dieser beiden zugelassenen und oftmals kombinierten Zytokine haben sich deshalb in Deutschland weitgehend durchgesetzt. IL-2- und IFN-α-basierte Kombinationstherapien erreichten ähnlich hohe Ansprechraten wie aggressivere Immunchemotherapiekonzepte. Nach Versagen dieser Therapie bestanden bislang jedoch keine weiteren therapeutischen Optionen.

Die vorliegende Arbeit soll einen Überblick über die aktuellen Möglichkeiten der systemischen Therapie verschaffen und sowohl die etablierte Zytokintherapie als auch neue Substanzen wie Tyrosinkinaseinhibitoren, monoklonale Antikörper und den mTOR-Inhibitor CCI-779 (mammalian target of Rapamycin) bezüglich ihrer Bedeutung betrachten.

Abstract

Cytokine-based immunotherapy was the only viable option in metastatic, nonresectable renal cell carcinoma (RCC) for many years. Systemic immunotherapy has become increasingly established as a standard therapy during the last 15 years. In this context, interleukin-2 (IL-2) and interferon-α (IFN-α) turned out to be the most effective single agents in RCC. Subsequently, the approved subcutaneous application of these compounds was the preferred administration route in Germany. Response rates with cytokine combination therapy were almost similar to those of more aggressive concepts using additional chemotherapeutic agents.

Currently, new compounds targeting specific signaling pathways are readily available and have passed clinical testing. Such small molecules like tyrosine kinase inhibitors, monoclonal antibodies, or the mTOR inhibitor CCI-779 may dramatically change the established concepts of systemic RCC treatment. This paper gives an overview of established, current, and evolving concepts of systemic therapy in RCC.

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Authors and Affiliations

  1. Bereich Urologische Onkologie, Klinik und Poliklinik für Urologie, Universität, Köln

    A. Heidenreich

  2. Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik, Prittwitz-Straße 43, 89075, Ulm

    M. Autenrieth & J. E. Gschwend

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  1. M. Autenrieth
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  2. A. Heidenreich
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  3. J. E. Gschwend
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Correspondence to J. E. Gschwend.

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Autenrieth, M., Heidenreich, A. & Gschwend, J.E. Systemische Therapie des metastasierten Nierenzellkarzinoms. Urologe 45, 594–599 (2006). https://doi.org/10.1007/s00120-006-1036-4

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  • DOI: https://doi.org/10.1007/s00120-006-1036-4

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