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Tối đa hóa thời gian kiểm soát bệnh trong ung thư thận di căn bằng các tác nhân nhắm mục tiêu: thỏa thuận của các chuyên gia
Tóm tắt
Với sáu tác nhân nhắm mục tiêu đã được phê duyệt (sorafenib, sunitinib, temsirolimus, bevacizumab [+interferon], everolimus và pazopanib), nhiều bệnh nhân mắc ung thư thận tế bào di căn (mRCC) sẽ nhận được nhiều liệu pháp điều trị khác nhau. Tuy nhiên, phương pháp xếp thứ tự tối ưu vẫn chưa được xác định. Một nhóm các chuyên gia châu Âu đã xem xét dữ liệu hiện có và chia sẻ kinh nghiệm lâm sàng của họ để tổng hợp một thỏa thuận chuyên gia về việc sử dụng tuần tự các tác nhân nhắm mục tiêu trong mRCC. Cho đến nay, có rất ít nghiên cứu tiềm năng về liệu pháp tuần tự. Inhibitor của mục tiêu mammalian rapamycin (mTOR) everolimus đã được phê duyệt để sử dụng ở những bệnh nhân đã thất bại trong điều trị bằng các inhibitor của yếu tố tăng trưởng nội mô mạch máu (VEGF) và thụ thể VEGF (VEGFR) dựa trên kết quả từ một nghiên cứu giai đoạn III kiểm soát giả dược; tuy nhiên, cho đến lúc đó, các tác nhân được cấp phép duy nhất trong dải mRCC là các inhibitor VEGF(R) (sorafenib, sunitinib và bevacizumab + interferon), và vì vậy, một khối lượng lớn chứng cứ đã tích lũy liên quan đến việc sử dụng chúng theo trình tự. Dữ liệu cho thấy việc sử dụng tuần tự các inhibitor VEGF(R) có thể là một chiến lược điều trị hiệu quả để đạt được lợi ích lâm sàng kéo dài. Vị trí tối ưu của từng tác nhân nhắm mục tiêu trong chuỗi điều trị vẫn chưa rõ ràng, và cần có dữ liệu từ các nghiên cứu lớn để xác định. Nghiên cứu giai đoạn III AXIS so sánh sorafenib tuyến hai với axitinib (bao gồm cả các inhibitor sau-VEGF(R)) đã hoàn thành, nhưng dữ liệu vẫn chưa được công bố; các nghiên cứu đang diễn ra khác bao gồm nghiên cứu giai đoạn III SWITCH so sánh sorafenib–sunitinib với sunitinib–sorafenib (NCT00732914); nghiên cứu giai đoạn III 404 so sánh temsirolimus với sorafenib sau sunitinib (NCT00474786) và nghiên cứu giai đoạn II RECORD 3 so sánh sunitinib–everolimus với everolimus–sunitinib (NCT00903175). Cho đến khi có thêm dữ liệu, việc xem xét phản ứng của bệnh nhân và khả năng chịu đựng của họ với liệu pháp có thể hỗ trợ quyết định hiện tại về thời điểm chuyển đổi và phương pháp điều trị nào sẽ chuyển đổi trong thực hành lâm sàng thực tế.
Từ khóa
#ung thư thận tế bào di căn #tác nhân nhắm mục tiêu #liệu pháp tuần tự #VEGF #mTORTài liệu tham khảo
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