Multidisciplinary systemic and local therapies for metastatic renal cell carcinoma: a narrative review.

IF 2.9 3区 医学 Q2 ONCOLOGY
Expert Review of Anticancer Therapy Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI:10.1080/14737140.2024.2362192
Martin Zarba, Ryo Fujiwara, Takeshi Yuasa, Fumitaka Koga, Daniel Y C Heng, Kosuke Takemura
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Abstract

Introduction: Systemic and local therapies for patients with metastatic renal cell carcinoma (mRCC) are often challenging despite the evolution of multimodal cancer therapies in the last decade. In this review, we will focus on recent multidisciplinary approaches for patients with mRCC.

Areas covered: Systemic therapies for patients with mRCC have been garnering attention particularly after the approval of immuno-oncology (IO) agents, including anti-programmed death 1/programmed death-ligand 1. IO combinations have significantly prolonged overall survival in patients with mRCC in the first-line setting. Regarding local therapies, cytoreductive nephrectomy (CN) has become less common in the post-Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques (CARMENA) trial era, even though CN may still benefit selected patients with mRCC. In addition, metastasis-directed local therapies, namely metastasectomy or stereotactic radiotherapy, particularly for oligo-metastatic lesions or brain metastases, may have a prognostic impact. Several ablative techniques are also evolving while maintaining high local control rates with acceptable safety.

Expert opinion: Multimodal cancer therapies are essential for conquering complex cases of mRCC. Modern systemic therapies including IO-based combination therapy as well as local therapies including CN, metastasectomy, stereotactic radiotherapy, and ablative techniques appear to improve oncologic outcomes of patients with mRCC, although appropriate patient selection is indispensable.

转移性肾细胞癌的多学科全身和局部疗法:综述。
导言:尽管近十年来多模式癌症疗法不断发展,但针对转移性肾细胞癌(mRCC)患者的全身和局部疗法往往充满挑战。在这篇综述中,我们将重点介绍近期针对 mRCC 患者的多学科疗法:mRCC患者的全身治疗一直备受关注,尤其是在包括抗程序性死亡1/程序性死亡配体1在内的免疫肿瘤学(IO)药物获得批准之后。在局部疗法方面,尽管细胞诱导性肾切除术(CN)仍可使部分 mRCC 患者受益,但在后癌症肾转移肾切除术和抗血管生成试验(CARMENA)时代,这种疗法已变得不那么常见。此外,转移灶定向局部疗法,即转移灶切除术或立体定向放射治疗,尤其是针对少转移病灶或脑转移灶的治疗,也可能对预后产生影响。一些消融技术也在不断发展,同时保持了较高的局部控制率和可接受的安全性:多模式癌症疗法对于攻克复杂的mRCC病例至关重要。专家观点:多模式癌症疗法对于攻克复杂的mRCC病例至关重要。包括以IO为基础的综合疗法在内的现代全身疗法,以及包括CN、转移灶切除术、立体定向放疗和消融技术在内的局部疗法,似乎都能改善mRCC患者的肿瘤预后,但适当的患者选择是必不可少的。
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来源期刊
CiteScore
5.10
自引率
3.00%
发文量
100
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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