转移性肾癌的靶向治疗

Targeted therapy of metastatic renal cell carcinoma

转移性肾癌是一种对于传统化、放疗较不敏感的不可治愈性疾病。虽然免疫治疗对部分患者具一定疗效,但疗效通常并不持久,且治疗可能导致严重的毒副作用。随着近年来对肾癌生物学及分子发病机制的加深理解,针对使用多种靶向治疗药物治疗肾癌的研究取得了可喜的成果。无论针对初治或以往治疗失败的患者,靶向治疗均显示出高于传统治疗的优越性。此外,治疗的耐受性非常良好,并不影响患者的生存质量。本综述将依据最新的临床证据,着重围绕目前主要的治疗进展加以分别阐述,同时简单概括相关的治疗靶点信息,力求使读者在基础和临床两方面对转移性肾癌的靶向治疗获得较为深刻的认识。

Surgery is the only curative treatment modality for renal cell carcinoma （RCC）. However, approximately 30% of patients who undergo successful nephrectomy for RCC will develop lecoregional or metastatic recurrence. Effective treatment for recurrent or metastatic RCC is limited. It is known that conventional radiation therapy and chemotherapy are relatively ineffective for RCC patients with distant metastases. Although immune therapy with high dose interleukin can provide disease control for a portion of patients with advanced RCC, its therapeutic effect usually is not sustainable. In addition, substantial adverse effects and complications have limited the use of high dose interleukin treatment. Advances in the understanding at the molecular level of cancer have led to much progress in the development of anti-cancer agents, including drugs of targeted cancer therapy. Targeted therapy is not only effective in cancer treatment, but also has reduced adverse effects compared with conventional chemotherapy and immune therapy. Much progress in the treatment of advanced RCC by targeted therapy has been achieved in recent years. In this review, we will illustrate the roles, mechanisms and effects of several targeted therapy agents, including the two newly FDA-approved drugs, sorafenib and sunitinib, in the treatment of advanced renal cell carcinoma.