Systemtherapie des metastasierten Nierenzellkarzinoms

 

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Zusammenfassung

In der Erstlinientherapie des metastasierten Nierenzellkarzinoms stehen weiterhin die Tyrosinkinasehemmer (TKI) Pazopanib und Sunitinib sowie für Patienten mit günstigem oder intermediärem Risikoprofil auch IFNα/Bevacizumab sowie für Hochrisikopatienten der mTOR Inhibitor Temsirolimus zur Verfügung. In der Zweitlinientherapie nach Zytokintherapie können Axitinib oder Pazopanib und nach Vortherapie mit einer TKI/VEGF gerichteten Therapie Axitinib oder Everolimus eingesetzt werden. Neue Substanzen wie der PD1 Antikörper Nivolumab und der Multikinasehemmer Cabozantinib haben in der Zweitlinie einen Überlebensvorteil gegenüber Everolimus gezeigt und sollten daher nach Zulassung in der Zweit- und Drittlinie aufgrund des Vorteils beim Gesamtüberleben eingesetzt werden.

Abstract

In metastatic ccRCC , the treatment options in 1st line treatment are still the tyrosinkinase inhibitors (TKI) pazopanib and sunitinib, for patients with low or intermediate risk additionally IFNα/bevacizumab and for high risk patients the mTOR inhibitor temsirolimus. In 2nd line following cytokine therapy, axitinib or pazopanib and following TKI /VEGF directed therapy axitinib or everolimus may be administered. New upcoming agents in RCC are the PD1 antibody nivolumab and the multikinase inhibitor Cabozantinib, which both showed an OS advantage compared to everolimus. After marketing authorization in Europe, these agents should therefore be preferred in 2nd and 3rd line therapy. Further agents are under investigation.

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