Was ist neu bei der Diagnostik und Therapie des Nierenzellkarzinoms?

Was ist neu?

Histologische Entitäten Die histopathologische Einteilung der Nierenzellkarzinome (RCC) wurde auch unter Berücksichtigung der molekularen Charakteristiken überarbeitet und als neue WHO-Klassifikation 2016 publiziert. Weiterhin wurde eine S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms publiziert.

Therapie In der Erstlinientherapie des metastasierten RCC sind Kombinationstherapien mit dem Tyrosinkinasehemmer (TKI) Axitinib und den Immuncheckpoint-Inhibitoren (IO) Pembrolizumab oder Avelumab, unabhängig vom Risikoprofil und histologischer Entität, und die Kombination Ipilimumab mit Nivolumab bei Patienten mit intermediärem und hohem Risikoprofil neuer Standard. Ab der Zweitlinientherapie können nach einer Kombinationstherapie von TKI+IO oder IO + IO Medikamente, besonders TKI (z. B. Cabozantinib, Sunitinib), gegeben werden, die noch nicht zuvor eingesetzt wurden. Die Evidenzlage nach Kombinationstherapien ist gering.

Neue Nebenwirkungen Die Immuncheckpoint-Inhibitoren können mit immunvermittelten Nebenwirkungen unterschiedlichen Schweregrads einhergehen. Betroffen sind vor allem der Gastrointestinaltrakt, Leber, Lunge, Haut und endokrine Organe. Eine rasche Diagnostik und ggf. Therapie mit Immunsuppressiva sind essenziell.

Abstract

Renal cell carcinomas (RCC) include different tumor entities, of which clear cell RCC is the most common tumor with approx. 75 % followed by the papillary RCC with 10–15 %. RCC are increasingly being diagnosed incidental in the context of abdominal diagnostics from other indications using sonography or cross-sectional imaging.

The prognosis of metastatic RCC has improved significantly due to new therapy options, especially through the use of immune checkpoint inhibitors (IO). In the first line, combination therapies of the tyrosine kinase inhibitor (TKI) axitinib with the PD-1 antibody pembrolizumab or the PDL-1 antibody avelumab apply regardless of the risk profile and histological entity, as well as the combination of the CTLA4 antibody ipilimumab with the PD-1 antibody nivolumab in patients with intermediate and high risk as new standards in therapy. The combinations lead to a higher response rate and longer survival. In the second line and subsequent lines, there is no evidence-based data after combination therapies, but drugs can be used that were not yet part of the first-line therapy.

Schlüsselwörter

Nierenzellkarzinom - Nephrektomie - Tyrosinkinase-Inhibitoren - Immuncheckpoint-Inhibitoren - Kombinationstherapien

Key words

renal cell carcinoma - nephrectomy - tyrosinkinase inhibitors - immunecheckpoint inhibitors - combination therapy

Publication History

Article published online:
03 June 2020

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