medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-419medsovet-7983Research ArticleОНКОУРОЛОГИЯONCOUROLOGYЛечение метастатического светлоклеточного рака почки: фокус на пациентах благоприятной прогностической группыTreatment of metastatic сlear cell renal cell carcinoma: focus on a group of patients with favourable prognosishttps://orcid.org/0000-0003-4443-9974РумянцевА. А.RumyantsevA. A.

Румянцев Алексей Александрович - к.м.н., заведующий отделением противоопухолевой лекарственной терапии №4 отдела лекарственного лечения Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова.

115478, Москва, Каширское шоссе, д. 24

Alexey A. Rumyantsev - Cand. Sci. (Med.), Head of Cancer Drug Therapy (Chemotherapeutic) Department No. 4, Medication-Based Treatment Unit, Trapeznikov Research Institute of Clinical Oncology, Blokhin National Medical Research Center of Oncology.

24, Kashirskoye Shosse, Moscow, 115478

alexeymma@gmail.comНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation2023170120240228086Copyright © Румянцев А.А., 20242024Румянцев А.А.Rumyantsev A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7983

Современные клинические рекомендации различных отечественных и зарубежных профессиональных сообществ указывают в качестве варианта выбора первой линии терапии метастатического светлоклеточного рака почки комбинированные режимы вне зависимости от группы прогноза пациента. Данная обзорная статья посвящена анализу современных данных о доказательной базе применения различных вариантов комбинированных режимов терапии у пациентов с метастатическим раком почки и оценке роли однокомпонентных вариантов противоопухолевой терапии в первоначальном лечении данного заболевания. Проанализированы результаты исследований, посвященных применению современных иммуноонкологических режимов терапии в первой линии лечения рака почки с акцентом на группу благоприятного прогноза, в т. ч. с учетом последних обновлений данных исследований по оценке эффективности комбинаций (пембролизумаб/акситиниб, пембролизумаб/ленватиниб, ниволумаб/кабозантиниб, авелумаб/акситиниб). Продемонстрировано, что, хотя использование отдельных комбинаций иммуноонкологических и таргетных препаратов обеспечивает лучшие показатели контроля заболевания, частоты объективного ответа и выживаемости без прогрессирования, ни одна из изученных комбинаций к настоящему моменту не показала достоверного увеличения общей выживаемости пациентов – ключевого показателя эффективности лечения при метастатическом опухолевом процессе. По результатам анализа сделан вывод о том, что монотерапия тирозинкиназными ингибиторами, например сунитинибом или пазопанибом, представляется достаточной и оптимальной с клинической и экономической точек зрения при лечении пациентов благоприятной прогностической группы. Для пациентов с благоприятным прогнозом монотерапия тирозинкиназными ингибиторами может быть основной, а не альтернативной терапевтической опцией до тех пор, пока не доказано преимущество комбинаций с точки зрения общей выживаемости.

Current clinical guidelines of various domestic and foreign professional communities indicate combination regimens as an option for the first-line therapy for metastatic сlear cell renal cell carcinoma, regardless of the patient’s prognosis group. This review article is devoted to the analysis of the current evidence base for the use of different variants of combination therapy regimens in patients with metastatic renal cell carcinoma and assessment of the role of single-component cancer therapy options in the initial treatment of this disease. We reviewed the results of studies of current immuno-oncology therapy regimens in the first-line renal cell carcinoma therapy with a focus on a favourable prognosis group, taking into account the latest updates from the studies evaluating the efficacy of combination treatments (pembrolizumab/axitinib, pembrolizumab/lenvatinib, nivolumab/cabozantinib, avelumab/axitinib). We found that although the use of certain combinations of immunooncology and targeted drugs give better results of disease control, objective response and progression-free survival rates, none of the studied combinations to date has shown a significant increase in overall patient survival rates, which is a key treatment efficacy indicator in metastatic cancer. Conclusions drawn from this review indicate that monotherapy with tyrosine kinase inhibitors, such as sunitinib or pazopanib, appears to be sufficient and optimal from a clinical and economic point of view in the treatment of a favourable prognosis group. For patients with a favourable prognosis, tyrosine kinase inhibitor monotherapy may be a primary rather than an alternative therapeutic option until the benefit of combinations in terms of overall survival rates has been showed.

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The authors declare that there are no conflicts of interest present.