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Dialyse aktuell 2012; 16(8): 458-461
DOI: 10.1055/s-0032-1329605
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Das metastasierte Nierenzellkarzinom – Medikamentöse Therapie

Metastatic renal cell carcinoma – Medicamentous therapy
Thomas Steiner
1   Klinik für Urologie, HELIOS Klinikum Erfurt GmbH, Erfurt (Chefarzt: Prof. Dr. Thomas Steiner)
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Publication History

Publication Date:
10 October 2012 (online)

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Die medikamentöse Therapie des metastasierten Nierenzellkarzinoms hat sich in den vergangenen Jahren grundlegend verändert. Basierend auf molekularbiologischen Erkenntnissen wurden Substanzen entwickelt, um gezielt in intra- und interzelluläre Signalwege einzugreifen. Die sogenannte Targettherapie bietet heute Patienten mit inkurablem Nierenzellkarzinom die Chance einer Überlebenszeitverlängerung bei akzeptablem Nebenwirkungsprofil. Verschiedene Tyrosinkinase- und mTOR-Inhibitoren wurden in unterschiedlichen Therapielinien prospektiv randomisiert geprüft, sodass in aktuellen Leitlinien einzelne Substanzen in definierten klinischen Szenarien empfohlen werden. Die optimale therapeutische Sequenz ist jedoch noch nicht definiert. Festzuhalten bleibt, dass alleinig die komplette chirurgische Resektion aller Tumormanifestationen dem Patienten eine potenziell kurative Therapiechance bietet und daher bei technischer Operabilität zu bevorzugen ist.

Systemic treatment of metastatic renal cell carcinoma has changed fundamentally over the last years. Based on molecular findings, substances have been developed to modify intra- and intercellular signal transduction. The so-called targeted therapy gives patients with incurable renal cell cancer the chance of prolonged survival with acceptable quality of life and manageable side effects. Several tyrosine kinase inhibitors and mTOR inhibitors have been evaluated in various clinical settings within prospective trials. Therefore, recent medical guidelines are able to give recommendations for the management of advanced renal cell carcinoma in daily practice. However, the optimal therapeutic sequence of the available substances has not been defined until now. Finally, it should be noted, that only the complete surgical removal of all tumor sites gives the patient a potentially curative option and should be preferred whenever technically feasible.

Key words

metastatic renal cell carcinoma - targeted therapy - mTOR inhibitor - VEGFr-TKI
 

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