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Aktuelle Urol 2017; 48(01): 72-78
DOI: 10.1055/s-0042-117572
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Interdisziplinäre Empfehlungen zur Behandlung des metastasierten Nierenzellkarzinoms 

Interdisciplinary Recommendations for the Treatment of Metastatic Renal Cell Carcinoma
Kurt Miller
1   Klinik für Urologie, Charité-Universitätsmedizin Berlin
,
Lothar Bergmann
2   Medizinische Klinik II, J.W. Goethe-Universität Frankfurt/Main
,
Christian Doehn
3   Urologikum Lübeck
,
Jürgen Gschwend
4   Klinik und Poliklinik für Urologie an der Technischen Universität München Klinikum rechts der Isar
,
Ulrich Keilholz
5   Charité-Med. Klinik III und Charité Comprehensive Cancer Center
› Author Affiliations
Further Information

Publication History

Publication Date:
12 April 2017 (online)

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Zusammenfassung

Die Prognose von Patienten mit einem metastasierten Nierenzellkarzinom (mRCC) hat sich dank zielgerichteter Substanzen deutlich verbessert. Überlebenszeiten von mehr als 2 Jahren sind realistisch. Die Fortschritte zeigen sich auch darin, dass zunehmend Therapieoptionen in Dritt- und weiteren Linien thematisiert werden.

Sunitinib, Pazopanib, die Kombination Bevacizumab+Interferon-alpha sowie Temsirolimus sind für die Erstlinie beim mRCC zugelassen. Sunitinib und Pazopanib haben eine Zulassung auch für die Zweitlinientherapie – für Pazopanib ist diese auf den Einsatz nach Zytokinen beschränkt. Everolimus (nach Therapie mit einem Tyrosinkinase-Inhibitor; TKI), Axitinib (nach Sunitinib- oder Zytokintherapie) sowie Sorafenib (nach Zytokintherapie) sind weitere Wirkstoffe für die Zweitlinien-Therapie.

In der Zweitlinientherapie gab es 3 Neuzulassungen: Nach Versagen einer gegen VEGF gerichteten Therapie können nun Nivolumab, Cabozantinib und Lenvatinib in Kombination mit Everolimus eingesetzt werden. Damit stehen zum ersten Mal eine zielgerichtete Immuntherapie und eine Kombination zielgerichteter Substanzen beim mRCC zur Verfügung.

Zur Frage nach der optimalen Sequenztherapie gibt es keine neuen Erkenntnisse. Bisher liegen Ergebnisse einer Phase-III-Studie vor, in der die geprüften Sequenzen Sorafenib-Sunitinib und Sequenz Sunitinib-Sorafenib gleichwertig waren.

Ziel eines interdisziplinären RCC-Expertengesprächs war es, gemeinsame Therapieempfehlungen auf Basis der aktuell publizierten Daten und der eigenen klinischen Erfahrung zu erarbeiten und für den Praxisalltag abzuleiten. Die Ergebnisse werden in dieser Publikation vorgestellt.

Abstract

Thanks to the use of targeted therapies, the prognosis of patients with metastatic renal cell carcinoma (mRCC) has improved significantly. A median overall survival of more than 2 years is a realistic claim. These improvements are also reflected in recent discussions about 3 and more lines of therapy.

Sunitinib, pazopanib, the combination of bevacizumab and interferon alpha, and temsirolimus are approved for first-line therapy of mRCC. Sunitinib and pazopanib are also approved for second-line therapy, which, for pazopanib, is confined to the use after cytokine failure. Everolimus (after tyrosine kinase inhibitor (TKI) treatment), sorafenib (after cytokines) and axitinib (after treatment with sunitinib or cytokines) are other compounds available for second-line therapy.

3 new substances have recently been approved for second-line therapy: Nivolumab, cabozantinib, and lenvatinib combined with everolimus can be used after VEGF-targeted treatment has failed. It is for the first time that targeted immunotherapy and a combination of targeted substances are available for the treatment of mRCC.

There is no new insight as to an optimal sequence therapy. Study results from a phase III trial suggest that the sequences sorafenib-sunitinib and sunitinib-sorafenib are equally effective.

The purpose of an interdisciplinary expert meeting on RCC was to work out joint treatment recommendations based on current data and clinical experience and to integrate them into clinical routine practice. The results are presented in this publication.

Schlüsselwörter

Nierenzellkarzinom - Metastasen - Medikamentöse Therapie

Key words

Renal cell cancer - Metastases - Medical treatment

** NCT-Studiennummern: www.clinicaltrials.gov


 

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