Interdisziplinäre Empfehlungen zur Behandlung des metastasierten Nierenzellkarzinoms

Zusammenfassung

Patienten mit metastasiertem Nierenzellkarzinom (mRCC) haben eine lebensbegrenzende Prognose. Die Zielsetzung der Therapie ist daher in der Regel palliativ. Dennoch konnten in den letzten Jahren deutliche Fortschritte erreicht werden. Die Immuntherapie mit Zytokinen in der palliativen Situation ist zunehmend durch neue zielgerichtete Substanzen abgelöst worden. Sunitinib, die Kombination Bevacizumab+Interferon-alpha, Pazopanib 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 TKI-Therapie) und Sorafenib (nach Zytokintherapie) sind weitere Substanzen, die in der Zweitlinientherapie zur Verfügung stehen. Neu zugelassen wurde Axitinib, es kann nach Versagen einer Sunitinib- oder Zytokintherapie eingesetzt werden. Zur Frage nach der optimalen Sequenz gibt es erste Studienergebnisse aus einer Phase III Studie. Welche Kriterien einer Therapieentscheidung zugrundgelegt werden sollten, wurde im Rahmen eines Expertenmeetings unter Berücksichtigung der 2012 publizierten Daten diskutiert. Wie in den Vorjahren war es auch diesmal das Ziel des interdisziplinären Expertengesprächs, gemeinsame Therapieempfehlungen auf Basis der publizierten Daten und der eigenen klinischen Erfahrung zu erarbeiten und für den Praxisalltag abzuleiten. Das interdisziplinäre Board knüpfte an Therapieempfehlungen aus dem Jahr 2012 an [1]. Die Publikation fasst die Ergebnisse der Diskussion zusammen und enthält einen aktuellen Therapiealgorithmus.

Abstract

Patients with metastatic renal cell carcinoma have a life-limiting prognosis. Therefore, the aim of therapy is normally palliative care. Nevertheless, substantial achievements have been made in the past years. Cytokines as long-term standard therapy have been more and more replaced by new targeted therapies. Sunitinib, the combination of bevacizumab+interferon alfa, pazopanib and temsirolimus are now approved for first-line therapy. Sunitinib and pazopanib can also be applied as second-line options – for pazopanib the use is restricted to cases of cytokine failure. Everolimus (after TKI therapy) and sorafenib (after cytokines) are other compounds available for second-line therapy. In addition, axitinib was recently approved for second-line therapy after failure of sunitinib or cytokines. For questions regarding the optimal sequence, first study results are now available from the phase III trial. The purpose of an interdisciplinary expert meeting held in 2012 was to debate upon which criteria should influence the therapy decision. The members discussed several aspects of treating patients with the disease. Results from the 2011 conference provided the basis for the 2012 meeting [1]. As in previous years, the experts intended to provide common recommendations for clinical practice. The results of the 2012 conference are presented as short theses and a current therapy algorithm.

Schlüsselwörter

Nierenzellkarzinom - Metastasen - Medikamentöse Therapie

Key words

renal cell cancer - metastases - targeted therapy

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