Jens Bedke, Thomas Gauler, Viktor Grünwald, Axel Hegele, Edwin Herrmann, Stefan Hinz, Jan Janssen, Stephan Schmitz, Martin Schostak, Hans Tesch, Stefan Zastrow, Kurt Miller
- Purpose: Current systemic treatment of targeted therapies, namely the vascular endothelial growth factor-antibody (VEGF-AB), VEGF receptor tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitors, have improved progression-free survival and replaced non-specific immunotherapy with cytokines in metastatic renal cell carcinoma (mRCC).
Methods: A panel of experts convened to review currently available phase 3 data for mRCC treatment of approved agents, in addition to available EAU guideline data for a collaborative review as the plurality of substances offers different options of first-, second- and third-line treatment with potential sequencing.
Results: Sunitinib and pazopanib are approved treatments in first-line therapy for patients with favorable- or intermediate-risk clear cell RCC (ccRCC). Temsirolimus has proven benefit over interferon-alfa (IFN-α) in patients with non-clear cell RCC (non-ccRCC). In the second-line treatment TKIs or mTOR inhibitors are treatment choices. Therapy options after TKI failure consist of everolimus and axitinib. Available third-line options consist of everolimus and sorafenib. Recently, nivolumab, a programmed death-1 (PD1) checkpoint inhibitor, improved overall survival benefit compared to everolimus after failure of one or two VEGFR-targeted therapies, which is likely to become the first established checkpoint inhibitor in mRCC. Data for the sequencing of agents remain limited.
Conclusions: Despite the high level of evidence for first and second-line treatment in mRCC, data for third-line therapy are limited. Possible sequences include TKI-mTOR-TKI or TKI–TKI-mTOR with the upcoming checkpoint inhibitors in perspective, which might settle a new standard of care after previous TKI therapy.
MetadatenAuthor: | Jens Bedke, Thomas Gauler, Viktor Grünwald, Axel Hegele, Edwin Herrmann, Stefan Hinz, Jan Janssen, Stephan Schmitz, Martin Schostak, Hans TeschORCiDGND, Stefan Zastrow, Kurt Miller |
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URN: | urn:nbn:de:hebis:30:3-441298 |
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DOI: | https://doi.org/10.1007/s00345-016-1868-5 |
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ISSN: | 1433-8726 |
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ISSN: | 0724-4983 |
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Pubmed Id: | https://pubmed.ncbi.nlm.nih.gov/27277600 |
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Parent Title (English): | World journal of urology |
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Publisher: | Springer |
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Place of publication: | Berlin ; Heidelberg |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2017/04/20 |
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Date of first Publication: | 2016/06/09 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2017/04/20 |
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Tag: | Checkpoint inhibitor; Renal cell carcinoma; Sequence; Systemic treatment; Targeted therapy; Tyrosine kinase inhibitor mTOR inhibition |
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Volume: | 35 |
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Issue: | 2 |
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Page Number: | 10 |
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First Page: | 179 |
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Last Page: | 188 |
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Note: | © The Author(s) 2016. This article is published with open access at Springerlink.com. Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
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HeBIS-PPN: | 423895117 |
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Institutes: | Medizin / Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - Namensnennung 4.0 |
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