Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press35110.17650/1726-9776-2012-8-4-22-26DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиOPTIMIZATION OF SECOND-LINE TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA CANCER AFTER USE OF VEGF RECEPTOR – TYROSINE KINASE INHIBITORS (LITERATURE REVIEW)ОПТИМИЗАЦИЯ ВТОРОЙ ЛИНИИ ТАРГЕТНОЙ ТЕРАПИИ МЕТАСТАТИЧЕСКОГО РАКА ПОЧКИ ПОСЛЕ ПРИМЕНЕНИЯ ИНГИБИТОРОВ ТИРОЗИНКИНАЗ РЕЦЕПТОРОВ VEGF (ОБЗОР ЛИТЕРАТУРЫ)SavkovR. V.СавковР. В.
Russian Federation

Отделение онкоурологии

dr.savkov@mail.ruDepartment of Urological Oncology, Moscow Regional Oncology Dispensary, BalashikhaГБУЗ МООД, Балашиха301220128422260708201407082014https://oncourology.abvpress.ru/oncur/article/view/351

Sequential targeted therapy is now the standard of treatment for metastatic renal cell carcinoma (mRCC). A switch into a different mechanism of action of mTOR inhibitor after vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKI) in second-line therapy helps to elude cumulative toxicity and cross-resistance, which may occur in the sequential use of different anti-VEGFR agents through the overlapping mechanisms of action. After VEGFR TKI therapy failure, treatment with the mTOR inhibitor everolimus in second-line therapy is recognized to be effective and safe, substantially increasing progression-free survival, without worsening its quality. Everolimus is recommended as second-line targeted treatment for patients with progressive mRCC after primary VEGFR TKI use. Switching to everolimus is warranted especially in patients who have a poor response to or a high toxicity of first-line antiangiogenic therapy.

В настоящее время последовательная таргетная терапия является стандартом лечения метастатического почечно-клеточ ного рака (мПКР). Смена механизма действия при использовании ингибитора mTOR после ингибиторов тирозинкиназы (ИТК) рецепторов VEGF (VEGFR) во 2-й линии терапии позволяет избежать кумулятивной токсичности и перекрестной резистентности, возможных при последовательном применении различных анти-VEGFR-агентов за счет частично перекрывающихся механизмов действия. Лечение ингибитором mTOR эверолимусом во 2-й линии терапии при безуспешности лечения ИТК VEGFR признано эффективным и безопасным, позволяющим существенно увеличить выживаемость без прогрессирования без ухудшения ка чества жизни пациентов. Эверолимус – рекомендованный стандарт 2-й линии таргетного лечения пациентов с мПКР при прогрессировании заболевания после первичного применения ИТК VEGFR. Переход на эверолимус в особенности оправдан у пациентов с прогрессированием или высокой токсичностью антиангиогенной терапии 1-й линии.

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