Aktuelles zur medikamentösen Therapie des rezidivierten/metastasierten Nierenzellkarzinom (mNCC)

Zusammenfassung

Das Nierenzellkarzinom gehört zu den häufigen malignen Tumoren bei weiterhin steigender Inzidenz über die letzten 10 Jahre. Bei zunehmend verbesserter Operationstechniken, Nierenerhalt und minimal invasiven Eingriffen in der Lokaltherapie primär resektabler, nicht metastasierter Stadien, bleiben adjuvante Behandlungskonzepte bislang nicht indiziert und die medikamentöse Therapie den fortgeschritten metastasierten oder rezidivierten Tumoren vorbehalten. Nachdem zu Beginn des Jahrtausends durch den Einsatz von Zytokinen, als erstem Immuntherapeutischen Ansatz, das Gesamtüberleben von Patienten mit Nierenzellkarzinom im median 13 Monate betrug, dominierte über die letzte Dekade die zielgerichtete Therapie mit Angiogeneseinhibitoren in Form von Antikörpern oder Tyrosinkinase-Inhibitoren (TKI), sowie der Therapieoption der mTOR-Inhibition. Demzufolge prägte die Wahl der therapeutischen Sequenztherapie die Diskussionen. Mittlerweile stellt die kombinierte Therapie mit Immun-Checkpoint-Inhibitoren (ICI) in der Erstlinientherapie des metastasierten Nierenzellkarzinoms einen neuen Standard dar und konnte das mediane Gesamtüberleben auf >40 Monate anheben. Tyrosinkinase-Inhibitoren haben als Kombinationspartner und in einzelnen Fällen auch als Monotherapie weiter ihren Stellenwert behalten. Derzeit sind in der Erstlinientherapie des Nierenzellkarzinoms in Deutschland eine rein immunonkologische Kombination und 3 Kombinationen aus jeweils einem Immun-Checkpoint-Inhibitor und einem TKI zugelassen.

Abstract

Renal cell carcinoma is a common malignant tumour, whose incidence is steadily increasing. Whilst operative techniques have recently improved, including possibilities of renal preservation and minimally invasive surgery, no use has been shown for adjuvant treatment strategies. When local therapies are not suitable in relapsed or metastatic disease, medical drug treatment is indicated. The first immunologic treatment for renal cell carcinoma consisted of cytokines and overall survival amounted to a median of 13 months. Over the last decade, tyrosine kinase inhibitors (TKI), which inhibit the tumour vasculature, dominated the therapeutic area and raised the clinical discussion about the best sequential pattern. More recently, checkpoint inhibitors (CPI) have set a new standard as therapeutic tools in renal cell cancer. Modern first-line therapies consist of checkpoint inhibitor-based combinations, which have shifted the median overall survival expectation to >40 months. However, tyrosine kinase inhibitors have retained their therapeutic value as combination partners and also as monotherapy in individual cases. One combined immunotherapy and 3 combinations of a checkpoint inhibitor and a TKI are currently approved in Germany.

Schlüsselwörter

fortgeschrittenes/metastasiertes Nierenzellkarzinom (mRCC) - Immun-Checkpoint-Inhibitoren (CPI) - Tyrosinkinaseinhibitoren (TKI) - Kombinationstherapien

Keywords

advanced/metastatic renal cell carcinoma (mRCC) - checkpoint inhibitors (CPI) - tyrosine kinase inhibitors (TKI) - combined therapy

Publication History

Received: 12 April 2021

Accepted after revision: 15 June 2021

Article published online:
24 August 2021

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