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Dtsch Med Wochenschr 2024; 149(04): 180-190
DOI: 10.1055/a-2013-0057
CME-Fortbildung

Das fortgeschrittene Nierenzellkarzinom – Aktuelle Systemtherapie im Überblick

Advanced renal cell carcinoma – an overview of current systemic therapy
Moritz Kaune
,
Carsten Bokemeyer
,
Gunhild von Amsberg
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Die einzige kurative Behandlungsmethode beim Nierenzellkarzinom (RCC) ist die chirurgische Resektion. Bei nicht resezierbarem/metastasiertem RCC ist die medikamentöse (Kombinations-)Therapie die wirksamste Behandlungsoption. Die systemische Therapie des fortgeschrittenen RCC richtet sich nach Tumorausdehnung, Behandlungsdruck, Begleiterkrankungen und persönlichen Umständen und muss individuell entschieden werden.

Abstract

Renal cell carcinoma (RCC) is one of the more common tumor diseases in older adults. The only curative treatment method is surgical resection in the localized stage. Based on current study data, drug (combination) therapy in the metastatic stage is the most effective treatment option for non-resectable/metastatic RCC (mRCC). Immuno-oncological combinations of 2 Checkpoint-Inhibitors (CPI) or CPIs and Tyrosine kinase inhibitors (TKI) are now standard in the first-line treatment of metastatic RCC. Since the results of foundational combination therapy studies are not fully comparable due to different study design and patient populations, additional clinical and patient-related criteria are required when making individual treatment decisions. The systemic therapy of advanced RCC is therefore based on tumor extent, treatment pressure, concomitant diseases, and personal circumstances. A decision on first-line therapy should be made individually as part of a “shared decision” with the patient. The selection of a second-line systemic therapy is based on individual criteria; the data available for a well-founded classification of a possible therapy sequence after progression to first-line therapy is sparse. Further investigations to optimize systemic therapy (expansion of combination therapy to triple combination of CPI+CPI+TKI) or evaluation of therapy in other histological subtypes of renal cell carcinoma are the subject of ongoing clinical studies.

Kernaussagen

  • Die dynamische Therapielandschaft der Systemtherapie des metastasierten Nierenzellkarzinoms hat sich innerhalb der letzten Jahrzehnte drastisch verändert; die Sequenztherapie von monotherapeutisch genutzten Therapeutika hat sich zu einem kombinationstherapeutischen Ansatz aus Immuntherapie und Tyrosinkinase-Inhibitor in der Erstlinie gewandelt.

  • Die Therapieentscheidung in der Erstlinie bei Patient*innen mit metastasiertem Nierenzellkarzinom sollte anhand der Tumorausdehnung, des Therapiedrucks, der Begleiterkrankungen und der persönlichen Lebensumstände sowie unter Betrachtung der individuellen Erkrankungsdynamik und der patienteneigenen Faktoren erfolgen.

  • Aktuelle Standardtherapien setzen sich aus einer Kombination aus Immuntherapeutika oder Immuntherapeutika und Tyrosinkinase-Inhibitoren zusammen, die sich auf Basis noch laufender Langzeitanalysen anhand der primären Ansprechrate und der Dauer des Therapieansprechens unterscheiden.

  • Die Auswahl einer systemtherapeutischen Zweitlinie erfolgt anhand individueller Kriterien; die Datenlage zur fundierten Einordnung einer eventuellen Therapiesequenz nach Progress auf Erstlinientherapie ist spärlich.

  • Weitere Untersuchungen zur Optimierung der Systemtherapie (Ausweitung der Kombinationstherapie auf eine 3-fachkombination aus CPI+CPI+TKI) oder Evaluation der Therapie bei anderen histologischen Subtypen des Nierenzellkarzinoms sind Gegenstand laufender klinischer Studien.

Schlüsselwörter

Nierenzellkarzinom - metastasiert - Systemtherapie - Immuntherapie

Keywords

renal cell carcinoma - metastatic - systemic therapy - immunotherapy


Publication History

Article published online:
29 January 2024

© 2024. Thieme. All rights reserved.

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