Neue Medikamente beim metastasierten Nierenzellkarzinom

Zusammenfassung

Die systemische Behandlung des metastasierten Nierenzellkarzinoms hat in den letzten Jahren eine rasante Wandlung erfahren. Hierzu haben Erkenntnisse über histologische Subtypen und damit assoziierte genetische Aberrationen entscheidend beigetragen. Außerdem sind verschiedene Signalwege identifiziert worden, die für eine Tumorprogression bzw. therapeutische Beeinflussbarkeit bedeutsam sind. Bis vor wenigen Jahren stand lediglich eine Immuntherapie unter Verwendung von Zytokinen zur Verfügung. In der vorliegenden Übersichtsarbeit werden neue Medikamente zur Therapie des metastasierten Nierenzellkarzinoms dargestellt. Diese beeinflussen insbesondere die VEGF-, EGFR- und mTOR-Signalwege. Vier Substanzen sind in Phase-III-Studien geprüft worden und für die Therapie des metastasierten Nierenzellkarzinoms zugelassen bzw. werden in Kürze zugelassen. Ferner gibt es eine Vielzahl von Substanzen, die Phase-I und –II-Studien getestet wurden oder werden. Derzeit existieren verschiedene Szenarien, welche die Therapieentscheidung beeinflussen. Hierzu gehören verschiedene Prognosegruppen, der Einsatz in der Erstlinien- bzw. Zeitlinientherapie, der Einsatz verschiedener Kombinationen sowie der Einfluss der histologischen Subtypen.

Abstract

Systemic therapy of metastatic kidney cancer has undergone dramatic changes over the past years. One reason for this is our increasing knowledge of different histological subtypes and associated genetic aberrations. Furthermore, signalling pathways have been identified to be relevant for tumour progression and therapeutic intervention. Until some years ago, systemic therapy for kidney cancer consisted of cytokines. In this review, new drugs for the treatment of metastatic kidney cancer are discussed. These drugs predominantly interact the VEGF, EGFR and mTOR signalling pathways. Four drugs have been studied in phase III trials and were (or will soon be) approved for treatment of metastatic kidney cancer. Additionally, many drugs are currently being tested in phase I and phase II trials. At present, the following scenarios have an impact on therapy decisions: different prognostic groups, first-line and second-line therapy, combination therapies and the impact of different histological subtypes.

Nierenzellkarzinom - Immuntherapie - Zytokine - Antikörper - Tyrosinkinase - small molecules - VEGF - EGFR - mTOR

kidney cancer - immunotherapy - cytokines - antibodies - tyrosine kinase - small molecules - VEGF - EGFR - mTOR

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