Zytokinbasierte und molekulare Therapie des metastasierten Nierenzellkarzinoms - eine aktuelle Analyse

Zusammenfassung

Die systemische Therapie des Nierenzellkarzinoms stellt eine Herausforderung in der Uroonkologie dar. Obwohl für die zytokinbasierte Immuntherapie kein international einheitliches Behandlungsschema existiert, gilt sie bislang als Standard in der Therapie des metastasierten Nierenzellkarzinoms. Ein zunehmendes Verständnis relevanter tumorbiologischer Mechanismen des Nierenzellkarzinoms hat zur Entwicklung zielgerichteter molekularer Therapieansätze geführt. Durch neue Tyrosinkinaseinhibitoren und Angiogenesehemmer konnte inzwischen eine Verlängerung des progressionsfreien und des Gesamtüberlebens bei Patienten mit fortgeschrittenem Nierenzellkarzinom gezeigt und somit ein entscheidender Fortschritt erzielt werden. Während eine Reihe wichtiger Aspekte zur Therapie sowie möglicher Kombinationen dieser Substanzen untereinander und mit Zytokinen noch unklar sind, ist damit zu rechnen, dass die zytokinbasierte Immuntherapie als Erstlinientherapie in Zukunft an Bedeutung verlieren wird. Die Erweiterung des therapeutischen Spektrums für das fortgeschrittene Nierenzellkarzinom um potenzielle neue Standards bei uneinheitlicher Definition der alten Standards erfordert eine aktuelle Bestandsaufnahme des Stellenwertes der systemischen Therapie dieser Tumorentität. Eine bessere Kenntnis molekularer Marker und ihrer prognostischen Bedeutung könnte in Zukunft den gezielten Einsatz der verschiedenen molekularen Therapieansätze beim individuellen Patienten ermöglichen. Bis solche Marker verfügbar sind und mehr Erkenntnisse zur molekularen Therapie beim Nierenzellkarzinom vorliegen, sollte eine sorgfältige Indikationsstellung der verschiedenen Therapieoptionen für den individuellen Patienten erfolgen.

Abstract

The systemic treatment of renal cell cancer represents a challenge for uro-oncologists. Although no internationally recognised treatment regime has been defined, cytokine therapy has been the standard of care for metastatic disease. The growing understanding of the relevant mechanisms in the molecular biology of renal cell carcinoma has led to the development of targeted therapies. Novel tyrosine kinase and angiogenesis inhibitors have had a beneficial effect on progression-free and overall survival in patients with advanced renal cell cancer and represented a significant progress. Even though several important aspects regarding treatments and combinations of these drugs with each other as well as with cytokines still remain unclear, cytokine therapy will probably become less important as a first-line treatment. With increasing therapeutic options becoming available as potential new standards and with the old standards being poorly defined, a critical analysis of the role of different systemic therapies for renal cell carcinoma is warranted. A better knowledge of molecular markers and their prognostic relevance could allow the rational use of different targeted therapies in individual patients in the future. Until such therapies become available, the systemic treatment options should be selected carefully in individual patients.

Schlüsselwörter

Nierenzellkarzinom - Zytokintherapie - Interferon - Interleukin - molekulare Therapie

Key words

renal cell cancer - cytokine therapy - interferon - interleukin - targeted therapy

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