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Erschienen in: Die Onkologie 4/2024

13.03.2024 | Nierenkarzinom | CME

Erstlinientherapie beim metastasierten Nierenzellkarzinom

verfasst von: Dr. med. Andreas Bruchbacher, Christopher Netsch, Andreas J. Gross

Erschienen in: Die Onkologie | Ausgabe 4/2024

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Zusammenfassung

In den letzten Jahren wurde die Erstlinientherapie beim metastasierten Nierenzellkarzinom durch die Einführung von Checkpoint-Inhibitoren (CPI) revolutioniert. Binnen weniger Jahre haben sich mehrere Kombinationstherapien von CPI und Tyrosinkinaseinhibitoren (TKI) als effektiv und sicher in der Anwendung dargestellt. Gemäß Leitlinien kommen nun je nach Risikoprofil bis zu 5 verschiedene Kombinationstherapien infrage. Anhand der derzeitigen Datenlage kann nicht zwischen den Therapien direkt unterschieden werden, da keine Vergleichsstudien vorliegen. Somit sind es oft individuelle Faktoren, die die Therapieentscheidung leiten. Essenziell ist v. a. eine klare Aufarbeitung des Patienten mit den jeweiligen Risikofaktoren und der Tumoridentität. Daher ist es umso wichtiger, komplexe Fälle in einem interdisziplinären Tumorboard zu besprechen.
Literatur
1.
Zurück zum Zitat Awmf (2023) S3-Leitlinie Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms Awmf (2023) S3-Leitlinie Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms
4.
Zurück zum Zitat Powles T (2021) Recent eUpdate to the ESMO clinical practice guidelines on renal cell carcinoma on cabozantinib and nivolumab for first-line clear cell renal cancer: renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up〈sup〉1〈/sup. Ann Oncol 32:422–423CrossRefPubMed Powles T (2021) Recent eUpdate to the ESMO clinical practice guidelines on renal cell carcinoma on cabozantinib and nivolumab for first-line clear cell renal cancer: renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up〈sup〉1〈/sup. Ann Oncol 32:422–423CrossRefPubMed
5.
Zurück zum Zitat Heng DYC, Xie W, Regan MM et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor–targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799CrossRefPubMed Heng DYC, Xie W, Regan MM et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor–targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799CrossRefPubMed
6.
Zurück zum Zitat Zentrum für Krebsregisterdaten (2022) Krebs in Deutschland 2017/2018. Zentrum für Krebsregisterdaten Zentrum für Krebsregisterdaten (2022) Krebs in Deutschland 2017/2018. Zentrum für Krebsregisterdaten
7.
Zurück zum Zitat Al-Bayati O, Hasan A, Pruthi D et al (2019) Systematic review of modifiable risk factors for kidney cancer. Urol Oncol 37:359–371CrossRefPubMed Al-Bayati O, Hasan A, Pruthi D et al (2019) Systematic review of modifiable risk factors for kidney cancer. Urol Oncol 37:359–371CrossRefPubMed
8.
Zurück zum Zitat Capitanio U, Bensalah K, Bex A et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75:74–84CrossRefPubMed Capitanio U, Bensalah K, Bex A et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75:74–84CrossRefPubMed
9.
Zurück zum Zitat Patard J‑J, Leray E, Rodriguez A et al (2003) Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma. Eur Urol 44:226–232CrossRefPubMed Patard J‑J, Leray E, Rodriguez A et al (2003) Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma. Eur Urol 44:226–232CrossRefPubMed
10.
Zurück zum Zitat Bianchi M, Sun M, Jeldres C et al (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23:973–980CrossRefPubMed Bianchi M, Sun M, Jeldres C et al (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23:973–980CrossRefPubMed
11.
Zurück zum Zitat Moch H, Amin MB, Berney DM et al (2022) The 2022 world health organization classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours. Eur Urol 82:458–468CrossRefPubMed Moch H, Amin MB, Berney DM et al (2022) The 2022 world health organization classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours. Eur Urol 82:458–468CrossRefPubMed
12.
Zurück zum Zitat Lipworth L, Morgans AK, Edwards TL et al (2016) Renal cell cancer histological subtype distribution differs by race and sex. BJU Int 117:260–265CrossRefPubMed Lipworth L, Morgans AK, Edwards TL et al (2016) Renal cell cancer histological subtype distribution differs by race and sex. BJU Int 117:260–265CrossRefPubMed
13.
Zurück zum Zitat Nickerson ML, Witte N, Im KM et al (2017) Molecular analysis of urothelial cancer cell lines for modeling tumor biology and drug response. Oncogene 36:35–46CrossRefPubMed Nickerson ML, Witte N, Im KM et al (2017) Molecular analysis of urothelial cancer cell lines for modeling tumor biology and drug response. Oncogene 36:35–46CrossRefPubMed
14.
Zurück zum Zitat Randall JM, Millard F, Kurzrock R (2014) Molecular aberrations, targeted therapy, and renal cell carcinoma: current state-of-the-art. Cancer Metastasis Rev 33:1109–1124CrossRefPubMed Randall JM, Millard F, Kurzrock R (2014) Molecular aberrations, targeted therapy, and renal cell carcinoma: current state-of-the-art. Cancer Metastasis Rev 33:1109–1124CrossRefPubMed
15.
Zurück zum Zitat Frees S, Kamal MM, Knoechlein L et al (2016) Differences in overall and cancer-specific survival of patients presenting with chromophobe versus clear cell renal cell carcinoma: a propensity score matched analysis. Urology 98:81–87CrossRefPubMed Frees S, Kamal MM, Knoechlein L et al (2016) Differences in overall and cancer-specific survival of patients presenting with chromophobe versus clear cell renal cell carcinoma: a propensity score matched analysis. Urology 98:81–87CrossRefPubMed
16.
17.
Zurück zum Zitat Cheville JC, Lohse CM, Zincke H et al (2004) Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol 28:435–441CrossRefPubMed Cheville JC, Lohse CM, Zincke H et al (2004) Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol 28:435–441CrossRefPubMed
18.
Zurück zum Zitat Motzer RJ, Bacik J, Schwartz LH et al (2004) Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 22:454–463CrossRefPubMed Motzer RJ, Bacik J, Schwartz LH et al (2004) Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 22:454–463CrossRefPubMed
19.
Zurück zum Zitat Choueiri TK, Apolo AB, Powles T et al (2018) A phase 3, randomized, open-label study of nivolumab combined with cabozantinib vs sunitinib in patients with previously untreated advanced or metastatic renal cell carcinoma (RCC; CheckMate 9ER). J Clin Oncol 36:TPS4598-TPS4598CrossRef Choueiri TK, Apolo AB, Powles T et al (2018) A phase 3, randomized, open-label study of nivolumab combined with cabozantinib vs sunitinib in patients with previously untreated advanced or metastatic renal cell carcinoma (RCC; CheckMate 9ER). J Clin Oncol 36:TPS4598-TPS4598CrossRef
20.
Zurück zum Zitat Motzer R, Alekseev B, Rha SY et al (2021) Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med 384:1289–1300CrossRefPubMed Motzer R, Alekseev B, Rha SY et al (2021) Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med 384:1289–1300CrossRefPubMed
21.
Zurück zum Zitat Motzer RJ, Tannir NM, Mcdermott DF et al (2018) Nivolumab plus Ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med 378:1277–1290CrossRefPubMedPubMedCentral Motzer RJ, Tannir NM, Mcdermott DF et al (2018) Nivolumab plus Ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med 378:1277–1290CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Rini BI, Plimack ER, Stus V et al (2019) Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 380:1116–1127CrossRefPubMed Rini BI, Plimack ER, Stus V et al (2019) Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 380:1116–1127CrossRefPubMed
23.
Zurück zum Zitat Flanigan RC, Mickisch G, Sylvester R et al (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171:1071–1076CrossRefPubMed Flanigan RC, Mickisch G, Sylvester R et al (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171:1071–1076CrossRefPubMed
24.
Zurück zum Zitat Heng DYC, Wells JC, Rini BI et al (2014) Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the international metastatic renal cell carcinoma database consortium. Eur Urol 66:704–710CrossRefPubMed Heng DYC, Wells JC, Rini BI et al (2014) Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the international metastatic renal cell carcinoma database consortium. Eur Urol 66:704–710CrossRefPubMed
25.
Zurück zum Zitat Bakouny Z, El Zarif T, Dudani S et al (2023) Upfront cytoreductive nephrectomy for metastatic renal cell carcinoma treated with immune checkpoint inhibitors or targeted therapy: an observational study from the international metastatic renal cell carcinoma database consortium. Eur Urol 83:145–151CrossRefPubMed Bakouny Z, El Zarif T, Dudani S et al (2023) Upfront cytoreductive nephrectomy for metastatic renal cell carcinoma treated with immune checkpoint inhibitors or targeted therapy: an observational study from the international metastatic renal cell carcinoma database consortium. Eur Urol 83:145–151CrossRefPubMed
26.
Zurück zum Zitat Powles TLA, Bex A, Procopio G, Porta C, Schmidinger M, Suarez C, de Velasco G (2020) eUpdate—renal cell carcinoma treatment recommendations Powles TLA, Bex A, Procopio G, Porta C, Schmidinger M, Suarez C, de Velasco G (2020) eUpdate—renal cell carcinoma treatment recommendations
27.
Zurück zum Zitat Albiges L, Tannir NM, Burotto M et al (2020) Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4‑year follow-up of the phase III CheckMate 214 trial. ESMO Open 5:e1079CrossRefPubMedPubMedCentral Albiges L, Tannir NM, Burotto M et al (2020) Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4‑year follow-up of the phase III CheckMate 214 trial. ESMO Open 5:e1079CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Tannir NM, Mcdermott DF, Escudier B et al (2020) Overall survival and independent review of response in CheckMate 214 with 42-month follow-up: first-line nivolumab + ipilimumab (N+I) versus sunitinib (S) in patients (pts) with advanced renal cell carcinoma (aRCC). J Clin Oncol 38:609–609CrossRef Tannir NM, Mcdermott DF, Escudier B et al (2020) Overall survival and independent review of response in CheckMate 214 with 42-month follow-up: first-line nivolumab + ipilimumab (N+I) versus sunitinib (S) in patients (pts) with advanced renal cell carcinoma (aRCC). J Clin Oncol 38:609–609CrossRef
30.
Zurück zum Zitat Powles T, Plimack ER, Soulières D et al (2020) Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. Lancet Oncol 21:1563–1573CrossRefPubMed Powles T, Plimack ER, Soulières D et al (2020) Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. Lancet Oncol 21:1563–1573CrossRefPubMed
31.
Zurück zum Zitat Choueiri TK, Powles T, Burotto M et al (2021) Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 384:829–841CrossRefPubMedPubMedCentral Choueiri TK, Powles T, Burotto M et al (2021) Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 384:829–841CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Choueiri TK, Motzer RJ, Rini BI et al (2020) Updated efficacy results from the JAVELIN Renal 101 trial: first-line avelumab plus axitinib versus sunitinib in patients with advanced renal cell carcinoma. Ann Oncol 31:1030–1039CrossRefPubMed Choueiri TK, Motzer RJ, Rini BI et al (2020) Updated efficacy results from the JAVELIN Renal 101 trial: first-line avelumab plus axitinib versus sunitinib in patients with advanced renal cell carcinoma. Ann Oncol 31:1030–1039CrossRefPubMed
33.
Zurück zum Zitat Anonymous (2021) ASCO 2021: pembrolizumab plus axitinib versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma: results from 42-month follow-up of KEYNOTE-426 Anonymous (2021) ASCO 2021: pembrolizumab plus axitinib versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma: results from 42-month follow-up of KEYNOTE-426
34.
Zurück zum Zitat Motzer RJ, Powles T, Burotto M et al (2022) Nivolumab plus cabozantinib versus sunitinib in first-line treatment for advanced renal cell carcinoma (CheckMate 9ER): long-term follow-up results from an open-label, randomised, phase 3 trial. Lancet Oncol 23:888–898CrossRefPubMedPubMedCentral Motzer RJ, Powles T, Burotto M et al (2022) Nivolumab plus cabozantinib versus sunitinib in first-line treatment for advanced renal cell carcinoma (CheckMate 9ER): long-term follow-up results from an open-label, randomised, phase 3 trial. Lancet Oncol 23:888–898CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Mcdermott DF, Huseni MA, Atkins MB et al (2018) Clinical activity and molecular correlates of response to atezolizumab alone or in combination with bevacizumab versus sunitinib in renal cell carcinoma. Nat Med 24:749–757CrossRefPubMedPubMedCentral Mcdermott DF, Huseni MA, Atkins MB et al (2018) Clinical activity and molecular correlates of response to atezolizumab alone or in combination with bevacizumab versus sunitinib in renal cell carcinoma. Nat Med 24:749–757CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Sternberg CN, Davis ID, Mardiak J et al (2010) Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 28:1061–1068CrossRefPubMed Sternberg CN, Davis ID, Mardiak J et al (2010) Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 28:1061–1068CrossRefPubMed
37.
Zurück zum Zitat Choueiri TK, Hessel C, Halabi S et al (2018) 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. Eur J Cancer 94:115–125CrossRefPubMedPubMedCentral Choueiri TK, Hessel C, Halabi S et al (2018) 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. Eur J Cancer 94:115–125CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Koh Y, Lim HY, Ahn JH et al (2013) Phase II trial of everolimus for the treatment of nonclear-cell renal cell carcinoma. Ann Oncol 24:1026–1031CrossRefPubMed Koh Y, Lim HY, Ahn JH et al (2013) Phase II trial of everolimus for the treatment of nonclear-cell renal cell carcinoma. Ann Oncol 24:1026–1031CrossRefPubMed
39.
Zurück zum Zitat Pal SK, Tangen C, Thompson IM Jr. et al (2021) A comparison of sunitinib with cabozantinib, crizotinib, and savolitinib for treatment of advanced papillary renal cell carcinoma: a randomised, open-label, phase 2 trial. Lancet 397:695–703CrossRefPubMedPubMedCentral Pal SK, Tangen C, Thompson IM Jr. et al (2021) A comparison of sunitinib with cabozantinib, crizotinib, and savolitinib for treatment of advanced papillary renal cell carcinoma: a randomised, open-label, phase 2 trial. Lancet 397:695–703CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat Mcdermott DF, Lee JL, Ziobro M et al (2021) Open-label, single-arm, phase II study of pembrolizumab monotherapy as first-line therapy in patients with advanced non-clear cell renal cell carcinoma. J Clin Oncol 39:1029–1039CrossRefPubMedPubMedCentral Mcdermott DF, Lee JL, Ziobro M et al (2021) Open-label, single-arm, phase II study of pembrolizumab monotherapy as first-line therapy in patients with advanced non-clear cell renal cell carcinoma. J Clin Oncol 39:1029–1039CrossRefPubMedPubMedCentral
Metadaten
Titel
Erstlinientherapie beim metastasierten Nierenzellkarzinom
verfasst von
Dr. med. Andreas Bruchbacher
Christopher Netsch
Andreas J. Gross
Publikationsdatum
13.03.2024

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