Systemische Therapie des metastasierten Nierenzellkarzinoms

Zusammenfassung

Ein verbessertes Verständnis der an der Pathogenese bzw. Progression des Nierenzellkarzinoms substanziell beteiligten molekularbiologischen Mechanismen führte in der jüngeren Vergangenheit zu einer grundlegenden Veränderung solcher Therapieansätze, die insbesondere nach erfolgter systemischer Disseminierung zur Anwendung gelangen. In diesem Sinne wurden Zytokin - basierte therapeutische Konzepte nahezu vollständig durch die sog. „targeted“ Therapeutika, die vor allem die Tyrosinkinase (TK) - und mTOR - Inhibitoren umfassen, ersetzt. Die vorliegende Arbeit soll den aktuellen Stand der Systemtherapie des Nierenzellkarzinoms in der Erstlinien- und Zweitlinientherapie reflektieren. Ferner wird der zunehmenden Bedeutung der Sequenztherapie unter Berücksichtigung möglicher Nebenwirkungen Beachtung geschenkt.

Abstract

A better understanding of molecular biological mechanisms involved in the pathogenesis or, respectively, prognosis of renal cell carcinoma has recently led to a fundamental change in those therapeutic options that are especially effective after systemic disemination. In this context, cytokine-based therapeutic concepts have been replaced by the so-called targeted therapeutic agents that include, above all, tyrosine kinase (TK) and mTOR inhibitors. The present contribution is intended to reflect the current state of the art in the systemic therapy for renal cell carcinoma in first- and second-line use. In addition, the increasing relevance of sequential therapy under consideration of possible side effects is discussed.

Schlüsselwörter

Nierenzellkarzinom - metastasiert - Systemtherapie - Tyrosinkinase-Inhibitoren - targeted Therapie

Key words

renal cell carcinoma - metastatic disease - systemic therapy - tyrosine kinase inhibitors - targeted therapy

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