Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press31610.17650/1726-9776-2012-8-3-37-42DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиEFFICIENCY OF TARGETED THERAPY USED IN THE HETEROGENEOUS POPULATION OF PATIENTS WITH METASTATIC KIDNEY CANCERЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ТАРГЕТНОЙ ТЕРАПИИ В ГЕТЕРОГЕННОЙ ПОПУЛЯЦИИ БОЛЬНЫХ МЕТАСТАТИЧЕСКИМ РАКОМ ПОЧКИAlekseevB. Ya.АлексеевБ. Я.
Russian Federation
byalekseev@mail.ruKalpinskyA. S.КалпинскийА. С.
Russian Federation
byalekseev@mail.ruP.A. Herzen Moscow Oncology Research InstituteМНИОИ им. П.А. Герцена, кафедра урологии с курсом онкоурологии ФПК МР РУДН, МоскваDepartment of Urology with a Course of Oncourology, Faculty of Advanced Training, People’s Friendship University of Russia, MoscowМНИОИ им. П.А. Герцена, кафедра урологии с курсом онкоурологии ФПК МР РУДН, МоскваP.A. Herzen Moscow Oncology Research InstituteDepartment of Urology with a Course of Oncourology, Faculty of Advanced Training, People’s Friendship University of Russia, Moscow300920128337420508201405082014https://oncourology.abvpress.ru/oncur/article/view/316

Most clinical trials were conducted on a thoroughly selected population of patients with mainly clear-cell metastatic renal-cell carcinoma (mRCC) without brain metastases and with a good somatic status. In routine clinical practice, the population of patients with mRCC is more heterogeneous: there are patients who have, in addition to the most common clear-cell mRCC, non-clear-cell mRCC, brain metastases and a somatic ECOG score of > 1. Undoubtedly, practitioners have a concern in the efficiency, tolerance, and expediency of using target drugs in all groups of patients with mRCC. This review gives a number of drugs approved for the treatment of mRCC and analyzes criteria for their choice.

Большинство клинических исследований провели на тщательно отобранной популяции пациентов с преимущественно светлоклеточными вариантами метастатического почечно-клеточного рака (мПКР) без метастазов в головной мозг и с хорошим соматическим статусом. В рутинной клинической практике популяция больных мПКР более гетерогенна: помимо наиболее распространенного светлоклеточного мПКР, встречаются пациенты с несветлоклеточными вариантами мПКР, метастазами в головной мозг и с соматическим статусом по шкале ECOG > 1. Несомненно, практикующих врачей интересует эффективность, переносимость и целесообразность применения таргетных препаратов у всех групп больных мПКР. В настоящем обзоре представлен ряд одобренных для лечения мПКР лекарственных препаратов и проанализированы критерии их выбора.

metastatic renal-cell carcinomatargeted therapytyrokinase inhibitorsметастатический почечно-клеточный рактаргетная терапияингибиторы тирозинкиназ1. Parkin D.M., Bray F., Ferlay J., Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74−108.Parkin D.M., Bray F., Ferlay J., Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74−108.2. Злокачественные новообразования в России в 2009 году. Под ред. В.И. Чиссова, В.В. Старинского, Г.В. Петрово. М., 2011.Злокачественные новообразования в России в 2009 году. Под ред. В.И. Чиссова, В.В. Старинского, Г.В. Петрово. М., 2011.3. Keane T., Gillatt D., Evans C.P., Tubaro A. Current and future trends in treatment of renal cancer. Eur Urol 2007;Suppl 6:374−84.Keane T., Gillatt D., Evans C.P., Tubaro A. Current and future trends in treatment of renal cancer. Eur Urol 2007;Suppl 6:374−84.4. Herbert T. Cohen, Francis J. McGovern. Renal-Cell Carcinoma. N Engl J Med 2005; 353:2477−90.Herbert T. Cohen, Francis J. McGovern. Renal-Cell Carcinoma. N Engl J Med 2005; 353:2477−90.5. Ljungberg B., Cowan N., Hanbury D.C. et al. Guidelines on renal cell carcinoma. European Association of Urology Web site. http://www.uroweb.org/guidelines/online-guidelines/.Ljungberg B., Cowan N., Hanbury D.C. et al. Guidelines on renal cell carcinoma. European Association of Urology Web site. http://www.uroweb.org/guidelines/online-guidelines/.6. National Comprehensive Cancer Network, Cancer — and Treatment — Kidney Cancer, Practice Guidelines in Oncology — v.1. 2012.National Comprehensive Cancer Network, Cancer — and Treatment — Kidney Cancer, Practice Guidelines in Oncology — v.1. 2012.7. Yagoda A., Abi-Rached, Petrylak D. Chemotherapy for advanced renal-cell carcinoma: 1983−1993. Semin Oncol 1995;22:42−60.Yagoda A., Abi-Rached, Petrylak D. Chemotherapy for advanced renal-cell carcinoma: 1983−1993. Semin Oncol 1995;22:42−60.8. Patard J.-J. New treatment options for renal cell cancer critical Evaluation. Eur Urol Suppl 2008;7:443−6.Patard J.-J. New treatment options for renal cell cancer critical Evaluation. Eur Urol Suppl 2008;7:443−6.9. Eisen T., Christmas T. Сlinical progress in renal cancer edited, London, 2007; р. 47−61, 173−191.Eisen T., Christmas T. Сlinical progress in renal cancer edited, London, 2007; р. 47−61, 173−191.10. Patard J.-J. Tyrosine kinase inhibitors in clinical practice: patient selection. Eur Urol Suppl 2008;7:601−9.Patard J.-J. Tyrosine kinase inhibitors in clinical practice: patient selection. Eur Urol Suppl 2008;7:601−9.11. Motzer R.J., Masumdar M., Bacic J. et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17(8):2530−40.Motzer R.J., Masumdar M., Bacic J. et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17(8):2530−40.12. Motzer R.J., Bacik J., Murphy B.A. et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20(1):289−96.Motzer R.J., Bacik J., Murphy B.A. et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20(1):289−96.13. Motzer R.J., Figlin R.A., Hutson T.E. et al. Sunitinib versus interferon-alfa (IFN-{alpha}) as first-line treatment of metastatic renal cell carcinoma (mRCC): updated results and analysis of prognostic factors [meeting abstracts]. J Clin Oncol 2007;25:5024.Motzer R.J., Figlin R.A., Hutson T.E. et al. Sunitinib versus interferon-alfa (IFN-{alpha}) as first-line treatment of metastatic renal cell carcinoma (mRCC): updated results and analysis of prognostic factors [meeting abstracts]. J Clin Oncol 2007;25:5024.14. Motzer R.J., Hutson T.E., Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356:115−24.Motzer R.J., Hutson T.E., Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356:115−24.15. Figlin R.A., Hutson T.E., Tomczak P. et al. Overall survival with Sunitinib versus interferonalfa (IFN-α) as first-line treatment of metastatic renal cell carcinoma (mRCC). J Clin Oncol 2008;26(Suppl.):256 s. Abstr.5024.Figlin R.A., Hutson T.E., Tomczak P. et al. Overall survival with Sunitinib versus interferonalfa (IFN-α) as first-line treatment of metastatic renal cell carcinoma (mRCC). J Clin Oncol 2008;26(Suppl.):256 s. Abstr.5024.16. Motzer R.J., Michaelson M.D., Hutson T.E. Sunitinib versus interferon alfa as first-line treatment of metastatic renal-cell carcinoma: updated efficacy and safety results and further analysis of prognostic factors. Eur J Cancer Suppl 2007;5:301. Abstr. 4509.Motzer R.J., Michaelson M.D., Hutson T.E. Sunitinib versus interferon alfa as first-line treatment of metastatic renal-cell carcinoma: updated efficacy and safety results and further analysis of prognostic factors. Eur J Cancer Suppl 2007;5:301. Abstr. 4509.17. Motzer R.J., Hutson T.E., 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 2009;27(22):3584−90.Motzer R.J., Hutson T.E., 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 2009;27(22):3584−90.18. Gore M., Szczylik C., Porta C. et al. Sunitinib in metastatic renal cell carcinoma (mRCC): preliminary assessment of safety and efficacy in an expanded access trial with subpopulation analysis. Eur J Cancer Suppl 2007;5:299. Abstr. 4503.Gore M., Szczylik C., Porta C. et al. Sunitinib in metastatic renal cell carcinoma (mRCC): preliminary assessment of safety and efficacy in an expanded access trial with subpopulation analysis. Eur J Cancer Suppl 2007;5:299. Abstr. 4503.19. Gore M.E., Szczylik C., Porta C. et al. Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol 2009;10(8):757−63.Gore M.E., Szczylik C., Porta C. et al. Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol 2009;10(8):757−63.20. Raymond E., Alexandre J., Faivre S. et al. Safety and pharmacokinetics of escalated doses of weekly intravenous infusion of CCI-779, a novel mTOR inhibitor, in patients with cancer. J Clin Oncol 2004;22:2336−47.Raymond E., Alexandre J., Faivre S. et al. Safety and pharmacokinetics of escalated doses of weekly intravenous infusion of CCI-779, a novel mTOR inhibitor, in patients with cancer. J Clin Oncol 2004;22:2336−47.21. Hudes G., Carducci M., Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007;356:2271−81.Hudes G., Carducci M., Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007;356:2271−81.22. Negrier S. Temsirolimus in metastatic renal cell carcinoma, Ann Onc 2008;19(8):1369−70.Negrier S. Temsirolimus in metastatic renal cell carcinoma, Ann Onc 2008;19(8):1369−70.23. Dutcher J.P., de Souza P., McDermott C. et al. Effect of temsirolimus versus interferonalpha on outcome of patients with advanced renal cell carcinoma of different tumor histologies. Med Oncol 2009;26:202−9.Dutcher J.P., de Souza P., McDermott C. et al. Effect of temsirolimus versus interferonalpha on outcome of patients with advanced renal cell carcinoma of different tumor histologies. Med Oncol 2009;26:202−9.24. Kapoor A., Figlin R.A. Targeted inhibition of mammalian target of rapamycin for the treatment of advanced renal cell carcinoma. Cancer 2009; 115:3618−30.Kapoor A., Figlin R.A. Targeted inhibition of mammalian target of rapamycin for the treatment of advanced renal cell carcinoma. Cancer 2009; 115:3618−30.25. Bellmunt J., Szczylik C., Feingold J., Strahs A. Temsirolimus safety profile and management of toxic effects in patients with advanced renal cell carcinoma and poor prognostic features. Ann Oncol 2008;19:1387−92.Bellmunt J., Szczylik C., Feingold J., Strahs A. Temsirolimus safety profile and management of toxic effects in patients with advanced renal cell carcinoma and poor prognostic features. Ann Oncol 2008;19:1387−92.26. Logan T., McDermott D., Dutcher J. et al. Exploratory analysis of the influence of nephrectomy status on temsirolimus efficacy in patients with advanced renal cell carcinoma and poor-risk features [abstract 5050]. J Clin Oncol 2008 ASCO Annual Meeting Proceedings. 2008; 26 part I, suppl 15S:262s.Logan T., McDermott D., Dutcher J. et al. Exploratory analysis of the influence of nephrectomy status on temsirolimus efficacy in patients with advanced renal cell carcinoma and poor-risk features [abstract 5050]. J Clin Oncol 2008 ASCO Annual Meeting Proceedings. 2008; 26 part I, suppl 15S:262s.27. Hudes G., Berkenblit A., Feingold J. et al. Clinical trial experience with temsirolimus in patients with advanced renal cell carcinoma. Semin Oncol 2009;36 (Suppl 3):26−36.Hudes G., Berkenblit A., Feingold J. et al. Clinical trial experience with temsirolimus in patients with advanced renal cell carcinoma. Semin Oncol 2009;36 (Suppl 3):26−36.