臨床泌尿器科66巻1号

2012年01月発行

特集 進行性腎癌に対する分子標的治療薬・薬剤選択ガイド

分子標的薬によるpresurgical治療の意義はあるか？

著者： 藤井靖久¹

所属機関： ¹がん研有明病院泌尿器科

ページ範囲：P.43 - P.48

文献概要

要旨　転移性腎癌に対する治療は，現在でも，即時の手術（主に腫瘍減量腎摘除）と，術後の全身治療が標準的である。分子標的薬によるpresurgical治療は，当初期待されたほどの効果が認められておらず，周術期合併症は増加する可能性が指摘されている。症例によっては，転移性腎癌で，まずは分子標的治療を行い，その効果と有害事象を評価し，腫瘍減量腎摘除で恩恵が得られそうな症例を選択し手術する，すなわちリトマス試験紙的なpresurgical治療，あるいは単腎や両側腎癌などのimperative症例における腎温存手術前のpresurgical治療は考慮してよいと思われる。

参考文献

1）Bex A, Jonasch E, Kirkali Z, et al：Integrating surgery with targeted therapies for renal cell carcinoma：current evidence and ongoing trials. Eur Urol 58：819-828, 2010

2）Choueiri TK, Xie W, Kollmannsberger C, et al：The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol 185：60-66, 2011

3）Wood CG and Margulis V：Neoadjuvant（presurgical）therapy for renal cell carcinoma：a new treatment paradigm for locally advanced and metastatic disease. Cancer 115（10 Suppl）：2355-2360, 2009

4）Thomas AA, Rini BI, Lane BR, et al：Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma. J Urol 181：518-523, 2009

5）Powles T, Kayani I, Blank C, et al：The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol 22：1041-1047, 2011

6）Yuasa T, Urakami S, Yamamoto S, et al：Tumor size is a potential predictor of response to tyrosine kinase inhibitors in renal cell cancer. Urology 77：831-835, 2011

7）Ficarra V and Novara G：Kidney cancer：neoadjuvant targeted therapies in renal cell carcinoma. Nat Rev Urol 7：63-64, 2010

8）Cost NG, Delacroix SE Jr, Sleeper JP, et al：The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol 59：912-918, 2011

9）Bex A, Van der Veldt AA, Blank C, et al：Progression of a caval vein thrombus in two patients with primary renal cell carcinoma on pretreatment with sunitinib. Acta Oncol 49：520-523, 2010

10）Silberstein JL, Millard F and Mehrazin R：Feasibility and efficacy of neoadjuvant sunitinib before nephron-sparing surgery. BJU Int 106：1270-1276, 2010

. Urology, in press

12）Wood CG：The role of cytoreductive nephrectomy in the management of metastatic renal cell carcinoma. Urol Clin North Am 30：581-588, 2003

13）Thomas AA, Rini BI, Stephenson AJ, et al：Surgical resection of renal cell carcinoma after targeted therapy. J Urol 182：881-886, 2009

14）Kondo T, Hashimoto Y, Kobayashi H, et al：Presurgical targeted therapy with tyrosine kinase inhibitors for advanced renal cell carcinoma：clinical results and histopathological therapeutic effects. Jpn J Clin Oncol 40：1173-1179, 2010

15）Calabrò F and Sternberg CN：Is there a role for presurgical therapy for renal cell carcinoma? Expert Rev Anticancer Ther 10：807-812, 2010

16）Margulis V, Matin SF, Tannir N, et al：Surgical morbidity associated with administration of targeted molecular therapies before cytoreductive nephrectomy or resection of locally recurrent renal cell carcinoma. J Urol 180：94-98, 2008

17）Karam JA, Rini BI, Varella L, et al：Metastasectomy after targeted therapy in patients with advanced renal cell carcinoma. J Urol 185：439-444, 2011