臨床泌尿器科72巻1号

2018年01月発行

特集 腎癌に対する薬物療法─最新エビデンスを実臨床に活かす

進行腎癌に対する術前後の補助薬物療法の意義

著者： 本郷文弥¹ 平岡健児¹ 浮村理¹

所属機関： ¹京都府立医科大学泌尿器外科学

ページ範囲：P.50 - P.57

文献概要

▶ポイント

・サイトカイン療法は腎摘除術前後の補助薬物療法として推奨できない．

・確立された治療方法はないものの，分子標的薬を用いたプレサージカル療法は一定の奏効率を示している．

・現時点では，アジュバント療法として有効な治療方法はないが，分子標的薬は一部の症例で無病生存期間を延長する可能性がある．

参考文献

1） Hollingsworth JM, Miller DC, Daignault S, et al : Five-year survival after surgical treatment for kidney cancer : a population-based competing risk analysis. Cancer 109 : 1763─1768, 2007

2） Babaian KN, Kim DY, Kenney PA, et al : Preoperative predictors of pathological lymph node metastasis in patients with renal cell carcinoma undergoing retroperitoneal lymph node dissection. J Urol 193 : 1101─1107, 2015

3） 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 Eng J Med 345 : 1655─1659, 2001

4） 日本泌尿器科学会 （編） : 腎癌診療ガイドライン2017年版. メディカルレビュー社, 東京, 2017

5） Rini BI, Garcia J, Elson P, et al : The effect of sunitinib on primary renal cell carcinoma and facilitation of subsequent surgery. J Urol 187 : 1548─1554, 2012

6） Karam JA, Devine CE, Urbauer DL, et al : Phase 2 trial of neoadjuvant axitinib in patients with locally advanced nonmetastatic clear cell renal cell carcinoma. Eur Urol 66 : 874─880, 2014

7） Zhang Y, Li Y, Deng J, et al : Sorafenib neoadjuvant therapy in the treatment of high risk renal cell carcinoma. PLoS One 10 : e0115896, 2015

8） Rini BI, Plimack ER, Takagi T, et al : A phase II Study of Pazopanib in Patients with Localized Renal Cell Carcinoma to Optimize Preservation of Renal Parenchyma. J Urol 194 : 297─303, 2015

9） Lane BR, Derweesh IH, Kim HL, et al : Presurgical sunitinib reduces tumor size and may facilitate partial nephrectomy in patients with renal cell carcinoma. Urol Oncol 33 : 112. e15─21, 2015

10） Powles T, Sarwar N, Stockdale A, et al : Safety and Efficacy of Pazopanib Therapy Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer. JAMA Oncol 2 : 1303─1309, 2016

11） Kim SH, Seo SI, Lee HM, et al : A prospective multicenter trial of the efficacy and tolerability of neoadjuvant sunitinib for inoperable metastatic renal cell carcinoma. J Korean Med Sci 31 : 1983─1988, 2016

12） 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

13） Horn T, Thalgott MK, Maurer T, et al : Presurgical treatment with sunitinib for renal cell carcinoma with a level III/IV vena cava tumour thrombus. Anticancer Res 32 : 1729─1735, 2012

14） Bigot P, Fardoun T, Bernhard JC, et al : Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy : is it useful? World J Urol 32 : 109─114, 2014

15） Sassa N, Kato M, Funahashi Y, et al : Efficacy of pre-surgical axitinib for shrinkage of inferior vena cava thrombus in a patient with advanced renal cell carcinoma. Jpn J Clin Oncol 44 : 370─373, 2014

16） Ujike T, Uemura M, Kawashima A, et al : Clinical and histopathological effects of presurgical treatment with sunitinib for renal cell carcinoma with inferior vena cava tumor thrombus at a single institution. Anticancer Drugs 27 : 1038─1043, 2016

17） Guo G, Cai W, Li H, et al : Presurgical neoadjuvant targeted molecular therapy for kidney cancer with concomitant vena cava tumor embolus : A clinical study. Oncol Lett 14 : 369─375, 2017

18） 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

19） 水野隆一, 大家基嗣 : 進行性腎細胞癌に対する術前薬物療法. 泌外29 : 969─974, 2016

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

21） Hellenthal NJ, Underwood W, Penetrante R, et al : Prospective clinical trial of preoperative sunitinib in patients with renal cell carcinoma. J Urol 184 : 859─864, 2010

22） Cowey CL, Amin C, Pruthi RS, et al : Neoadjuvant clinical trial with sorafenib for patients with stage II or higher renal cell carcinoma. J Clin Oncol 28 : 1502─1507, 2010

23） Pizzocaro G, Piva L, Colavita M, et al : Interferon adjuvant to radical nephrectomy in Robson stages II and III renal cell carcinoma : a multicentric randomized study. J Clin Oncol 19 : 425─431, 2001

24） Messing EM, Manola J, Wilding G, et al : Phase III study of interferon alfa-NL as adjuvant treatment for resectable renal cell carcinoma : an Eastern Cooperative Oncology Group/Intergroup trial. J Clin Oncol 21 : 1214─1222, 2003

25） Clark JI, Atkins MB, Urba WJ, et al : Adjuvant high-dose bolus interleukin-2 for patients with high-risk renal cell carcinoma : a cytokine working group randomized trial. J Clin Oncol 21 : 3133─3140, 2003

26） Atzpodien J, Schmitt E, Gertenbach U, et al : Adjuvant treatment with interleukin-2- and interferon-alfa2a-based chemoimmunotherapy in renal cell carcinoma post tumour nephrectomy : results of a prospectively randomized trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group （DGCIN）. Br J Cancer 92 : 843─846, 2005

27）Passalacqua R, Caminiti C, Buti S, et al : Adjuvant low-dose interleukin-2 （IL-2） plus interferon-α （INF-α） in operable renal cell carcinoma （RCC） : a phase III, randomized, multicentre trial of the Italian Oncology Group for Clinical Research （GOIRC）. J Immunother 37 : 440─447, 2014

28） Chamie K, Donin NM, KlÖpfer P, et al : Adjuvant Weekly Girentuximab Following Nephrectomy for High-Risk Renal Cell Carcinoma : the Ariser Randomized Clinical Trial. JAMA Oncol 3 : 913─920, 2017

29） Haas NB, Manola J, Uzzo RG, et al : Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma （ECOG-ACRIN E2805） : a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet 387 : 2008─2016, 2016

30） Ravaud A, Motzer RJ, Pandha HS, et al : Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy. N Eng J Med 375 : 2246─2254, 2016

31） Lenis AT, Donin NM, Johnson DC, et al : Adjuvant Therapy for High Risk Localized Kidney Cancer : Emerging Evidence and Future Clinical Trials. J Urol, 2017 ［Epub ahead of print］

32） Escudier B and Staehler : New Insights into Adjuvant Renal Cell Carcinoma Treatment with Vascular Endothelial Growth Factor Inhibitors : What Have We Learned so Far? Eur Urol, 2017 ［Epub ahead of print］

33） Motzer RJ, Haas NB, Donskov F, et al : Randomized Phase III Trial of Adjuvant Pazopanib Versus Placebo after Nephrectomy in Patients with Localized or Locally Advanced Renal Cell Carcinoma. J Clin Oncol, 2017 ［Epub ahead of print］