ログイン
ランキング
お知らせ
ログイン
文献詳細
特集 分子標的薬時代開幕5年目を迎えた進行腎癌の治療戦略の現状と展望
文献概要
要旨 転移性腎癌症例に対しては，免疫療法の時代より原発巣摘除（cytoreductive nephrectomy：CN）や転移巣摘除などの手術療法が推奨されている。分子標的薬により高い奏効率が得られる時代となったが，やはり予後延長効果は6か月程度と大きくはない。そのメリットを最大限に生かすには，免疫療法時代に確立した手術療法をうまく組み合わせていくことではないかと考えている。CNや転移巣切除も後向き研究の結果のみであるが，分子標的薬の時代でも重要な治療オプションであることが示されている。術前分子標的治療を行うということも1つの方法になる可能性はあるが，いまのところその意義は明らかとなっていない。ただ分子標的薬による全身治療を漫然と行うのではなく，常に手術療法の可能性やタイミングを念頭に置きながら薬物治療を行うことが重要であると思われる。
参考文献
1）日本泌尿器科学会（編）：腎癌診療ガイドライン2011年版．金原出版，東京，2011
2）Coppin C, Porzsolt F, Awa A, et al：Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev. 2005：CD001425.
3）Motzer RJ, Hutson TE, Tomczak P, et al：Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356：115-124, 2007
4）Flanigan RC, Salmon SE, Blumenstein BA, et al：Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345：1655-1669, 2001
5）Mickisch GH, Garin A, van Poppel H, et al：Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma：a randomised trial. Lancet 358：966-970, 2001
6）Flanigan RC, Mickisch G, Sylvester R, et al：Cytoreductive nephrectomy in patients with metastatic renal cancer：a combined analysis. J Urol 171：1071-1076, 2004
7）Ljungberg B, Cowan N, Hanbury DC, et al：Guidelines on renal cell carcinoma. European Association of Urology, Arnhem, 2011
8）Escudier B, Eisen T, Stadler WM, et al：Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356：125-134, 2007
9）Escudier B, Pluzanska A, Koralewski P, et al：Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma：a randomised, double-blind phase Ⅲ trial. Lancet 370：2103-2111, 2007
10）Hudes G, Carducci M, Tomczak P, et al：Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356：2271-2281, 2007
11）Motzer RJ, Hutson TE, Tomczak P, et al：Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 27：3584-3590, 2009
12）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［Multicenter Study］185：60-66, 2011
13）You D, Jeong IG, Ahn JH, et al：The value of cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy. J Urol［Research Support, Non-U. S. Gov't］185：54-59, 2011
14）Richey SL, Culp SH, Jonasch E, et al：Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. Ann Oncol 22：1048-1053, 2011
15）Escudier B：Benefit of cytoreductive nephrectomy in metastatic RCC：do we learn from retrospective studies and small prospective studies? Ann Oncol［Comment Editorial］22：995-996, 2011
16）Rini BI and Campbell SC：The evolving role of surgery for advanced renal cell carcinoma in the era of molecular targeted therapy. J Urol 177：1978-1984, 2007
17）Abel EJ and Wood CG：Cytoreductive nephrectomy for metastatic RCC in the era of targeted therapy. Nat Rev Urol 6：375-383, 2009
18）van der Poel HG, Roukema JA, Horenblas S, et al：Metastasectomy in renal cell carcinoma：a multicenter retrospective analysis. Eur Urol 35：197-203, 1999
19）Vogl UM, Zehetgruber H, Dominkus M, et al：Prognostic factors in metastatic renal cell carcinoma：metastasectomy as independent prognostic variable. Br J Cancer 95：691-698, 2006
20）Naito S, Yamamoto N, Takayama T, et al：Prognosis of Japanese metastatic renal cell carcinoma patients in the cytokine era：a cooperative group report of 1463 patients. Eur Urol 57：317-325, 2010
21）Kavolius JP, Mastorakos DP, Pavlovich C, et al：Resection of metastatic renal cell carcinoma. J Clin Oncol 16：2261-2266, 1998
22）Daliani DD, Tannir NM, Papandreou CN, et al：Prospective assessment of systemic therapy followed by surgical removal of metastases in selected patients with renal cell carcinoma. BJU Int 104：456-460, 2009
23）Eggener SE, Yossepowitch O, Kundu S, et al：Risk score and metastasectomy independently impact prognosis of patients with recurrent renal cell carcinoma. J Urol 180：873-878（discussion 8）, 2008
24）Alt AL, Boorjian SA, Lohse CM, et al：Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer 117：2873-882, 2011
25）Escudier B, Szczylik C, Hutson TE, et al：Randomized phase Ⅱ trial of first-line treatment with sorafenib versus interferon Alfa-2a in patients with metastatic renal cell carcinoma. J Clin Oncol 27：1280-1289, 2009
26）Hinotsu S, Kawai K, Ozono S, et al：Randomized controlled study of natural interferon alpha as adjuvant treatment for stage Ⅱ or Ⅲ renal cell carcinoma. Int J Clin Oncol. 2011 Nov 9.［Epub ahead of print］
27）Kwak C, Park YH, Jeong CW, et al：No role of adjuvant systemic therapy after complete metastasectomy in metastatic renal cell carcinoma? Urol Oncol 25：310-316, 2007
28）Sciarra A, Cattarino S, Salciccia S, et al：The emerging role of targeted therapy in renal cell carcinoma（RCC）：is it time for a neoadjuvant or an adjuvant approach? Crit Rev Oncol Hematol 81：151-162, 2012
29）Grossman HB, Natale RB, Tangen CM, et al：Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349：859-866, 2003
30）Roach M 3rd, Bae K, Speight J, et al：Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer：long-term results of RTOG 8610. J Clin Oncol 26：585-591, 2008
31）Bex A, Horenblas S, Meinhardt W, et al：The role of initial immunotherapy as selection for nephrectomy in patients with metastatic renal cell carcinoma and the primary tumor in situ. Eur Urol 42：570-574（discussion 5-6）, 2002
32）Wood CG and Margulis V：Neoadjuvant（presurgical）therapy for renal cell carcinoma：a new treatment paradigm for locally advanced and metastatic disease. Cancer 115：2355-2360, 2009
33）Abel EJ, Culp SH, Tannir NM, et al：Primary tumor response to targeted agents in patients with metastatic renal cell carcinoma. Eur Urol 59：10-15, 2011
34）Ficarra V and Novara G：Kidney cancer：neoadjuvant targeted therapies in renal cell carcinoma. Nat Rev Urol 7：63-64, 2010
35）Karakiewicz PI, Suardi N, Jeldres C, et al：Neoadjuvant sutent induction therapy may effectively down-stage renal cell carcinoma atrial thrombi. Eur Urol 53：845-848, 2008
36）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
37）Chapin BF, Delacroix SE Jr, Culp SH, et al：Safety of presurgical targeted therapy in the setting of metastatic renal cell carcinoma. Eur Urol 60：964-971, 2011
38）Thomas AA, Rini BI, Stephenson AJ, et al：Surgical resection of renal cell carcinoma after targeted therapy. J Urol 182：881-886, 2009
39）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
40）Harshman LC, Yu RJ, Allen GI, et al：Surgical outcomes and complications associated with presurgical tyrosine kinase inhibition for advanced renal cell carcinoma（RCC）. Urol Oncol. 2011 Feb 24.［Epub ahead of print］
41）Powles T, Blank C, Chowdhury S, et al：The Outcome of Patients Treated with Sunitinib Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer. Eur Urol 60：448-454, 2011
42）Kirkali Z and Van Poppel H：A critical analysis of surgery for kidney cancer with vena cava invasion. Eur Urol 52：658-662, 2007
43）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
44）Scappaticci FA, Fehrenbacher L, Cartwright T, et al：Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol 91：173-180, 2005
掲載誌情報
