Empfehlungen zur systemischen Therapie des metastasierten Nierenzellkarzinoms 2019

Zusammenfassung

Für die Behandlung des metastasierten Nierenzellkarzinoms steht eine Vielzahl an Medikamenten für die Systemtherapie zur Verfügung. Diese werden sowohl in der Erst- als auch Zweitlinientherapie und in späteren Linien eingesetzt. Die vorliegende Übersichtsarbeit beschreibt die in Deutschland zugelassenen Medikamente der Tyrosinkinase-, mTOR- und Immuncheckpointinhibition für die Systemtherapie des metastasierten klarzelligen Nierenzellkarzinoms und gibt eine Empfehlung für deren klinischen Einsatz aufgrund der vorhanden Phase II- und Phase III-Studiendaten. Des Weiteren werden detailliert die potenziellen Nebenwirkungen der einzelnen Substanzen beschrieben.

Abstract

Numerous substances are available for the treatment of metastatic renal cell carcinoma (mRCC). Therefore, medical treatment of patients with mRCC has become a very complex subject. This review summarises clinical studies and typical side-effects of currently available agents that have been approved in Germany. The authors give suggestions for the use of these substances in the different therapy lines.

Schlüsselwörter

Nierenzellkarzinom - Überleben - Prognose - Systemtherapie - Leitlinie

Keywords

renal cell carcinoma - prognosis - systemic therapy - guidelines

• Literatur

• 1 Coppin C, Porzsolt F, Awa A. et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev 2005; .pub2: CD001425
• 2 Motzer RJ, Hutson TE, McCann L. et al. Overall survival in renal-cell carcinoma with pazopanib versus sunitinib. The New England journal of medicine 2014; 370: 1769-1770
• 3 Motzer RJ, Hutson TE, Tomczak P. et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 2009; 27: 3584-3590
• 4 Motzer RJ, Hutson TE, Cella D. et al. Pazopanib versus sunitinib in metastatic renal-cell carcinoma. The New England journal of medicine 2013; 369: 722-731
• 5 Escudier B, Bellmunt J, Negrier S. et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol 2010; 28: 2144-2150
• 6 Hudes G, Carducci M, Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. The New England journal of medicine 2007; 356: 2271-2281
• 7 Choueiri TK, Hessel C, Halabi S. et al. Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): Progression-free survival by independent review and overall survival update. European journal of cancer 2018; 94: 115-125
• 8 Motzer RJ, Nosov D, Eisen T. et al. Tivozanib versus sorafenib as initial targeted therapy for patients with metastatic renal cell carcinoma: results from a phase III trial. J Clin Oncol 2013; 31: 3791-3799
• 9 Motzer RJ, Tannir NM, McDermott DF. et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. The New England journal of medicine 2018; 378: 1277-1290
• 10 Tannir NM, Frontera OA, Hammers HJ. et al. Thirty-month follow-up of the phase III CheckMate 214 trial of first-line nivolumab + ipilimumab (N+I) or sunitinib (S) in patients (pts) with advanced renal cell carcinoma (aRCC). Journal of Clinical Oncology 2019; 37: 547-547
• 11 Rini BI, Escudier B, Tomczak P. et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet 2011; 378: 1931-1939
• 12 Motzer RJ, Escudier B, Oudard S. et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma : final results and analysis of prognostic factors. Cancer 2010; 116: 4256-4265
• 13 Choueiri TK, Escudier B, Powles T. et al. Cabozantinib versus Everolimus in Advanced Renal-Cell Carcinoma. The New England journal of medicine 2015; 373: 1814-1823
• 14 Bedke J, Todenhofer T, Stenzl A. [Immune checkpoint inhibition in metastatic urothelial carcinoma]. Aktuelle Urol 2018; 49: 178-186
• 15 Motzer RJ, Escudier B, McDermott DF. et al. Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma. The New England journal of medicine 2015; 373: 1803-1813
• 16 Motzer RJ, Hutson TE, Glen H. et al. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. The Lancet Oncology 2015; 16: 1473-1482
• 17 Eichelberg C, Vervenne WL, De Santis M. et al. SWITCH: A Randomised, Sequential, Open-label Study to Evaluate the Efficacy and Safety of Sorafenib-sunitinib Versus Sunitinib-sorafenib in the Treatment of Metastatic Renal Cell Cancer. European urology 2015; 68: 837-847
• 18 Goebell PJ, Bedke J. [Molecular Concepts of Immunomodulation for the Treatment of Metastatic Renal Cell Carcinomas: Where are We Now?]. Aktuelle Urol 2015; 46: 473-480
• 19 Escudier B, Sharma P, McDermott DF. et al. CheckMate 025 Randomized Phase 3 Study: Outcomes by Key Baseline Factors and Prior Therapy for Nivolumab Versus Everolimus in Advanced Renal Cell Carcinoma. European urology 2017; 72: 962-971