2018年肾癌内科治疗进展盘点

Review of progress in renal cancer therapy in 2018

近年来我国肾癌发病率呈快速增高趋势,其中约四分之一患者初诊时已有转移,而转移患者的5年生存率不足10%。从2005年开始,索拉菲尼、舒尼替尼、培唑帕尼、阿昔替尼、卡博替尼、仑伐替尼等靶向药物的相继出现,使晚期肾癌的治疗有效率和生存期得到不断提高。2015年,纳武利尤单抗二线治疗晚期肾癌获得生存获益,标志着晚期肾癌的治疗进入免疫治疗时代。但这种免疫治疗所获得的中位PFS时间短,与靶向药物比较并无明显优势,因此免疫联合治疗成为了主流趋势。2018年的美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)年会和欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)年会均公布了令人振奋的免疫联合治疗的重磅研究以及疗效预测标志物的探索性研究结果。此外,近年来多项靶向药物临床研究对高危肾癌术后辅助治疗的价值进行了验证,包括2018年ESMO年会上报道的阿昔替尼辅助治疗研究,但这些研究结果均不尽如人意。在此,本文将对2018年肾癌治疗领域发生的重要事件做出年终盘点。

The incidence of renal cell carcinoma(RCC) in China has been increasing rapidly in recent years.About a quarter of the patients have metastasis at the time of initial diagnosis,while the 5-year survival rate of them is less than 10%.Since 2005,targeting drugs such as Sorafenib,Sunitinib,Pazopanib,Axitinib,Cabozantinib and Lenvatinib have appeared one after another,which has improved the response rate and survival of advanced RCC.In 2015,the second-line treatment Nivolumab has gained survival benefits,marking the era of immunotherapy.However,the immune therapy yield a short median progression-free survival time and no significant advantages compared with targeted drugs.Therefore,combined immunotherapy has become the mainstream trend.The annual meeting of the American Society of Clinical Oncology(ASCO) and the European Society of Medical Oncology(ESMO) in 2018 both published exciting results of the blockbuster study of combined immunotherapy and exploratory research results of predictive markers for efficacy.In addition,in recent years,many clinical studies of targeted drugs have validated the value of adjuvant therapy for high-risk RCC,including the study on the adjuvant therapy with Axitinib reported at the 2018 ESMO annual meeting,but the results are not satisfactory.Here,we will make a year-end inventory of these important events in the field of RCC treatment in 2018.