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.
Schlüsselwörter
Nierenzellkarzinom - metastasiert - Systemtherapie - Immuntherapie
Keywords
renal cell carcinoma - metastatic - systemic therapy - immunotherapy
