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    ABSTRACT: Die systemische Therapie des metastasierten Nierenzellkarzinoms hat sich in den letzten 5Jahren komplett geändert. Obwohl sich eine Heilung der Erkrankung mit einer systemischen Behandlung immer noch nicht erreichen lässt, wird eine Immuntherapie in den meisten Fällen nicht mehr angewendet. Die therapeutischen Regimes basieren hauptsächlich auf Angiogenesehemmern wie Sutinib, Sorafenib, Pazopanib, Everolimus und Temsirolimus wie auch auf einer Kombination aus Bevacizumab und Interferon. Wir geben einen Überblick über diese Therapieoptionen und die klinischen Situationen ihrer Anwendung. Um ein verlängertes progressionsfreies Überleben zu erreichen, ist eine kontinuierliche Therapie basierend auf den neuen Medikamenten notwendig. Das Hauptziel der Behandlung bleibt, die Erkrankung stabil zu halten, da vollständige Remissionen nur in 2 bis 4% der Fälle beobachtet werden. Angesichts dieser langwierigen Behandlungsregimes ist für die meisten Patienten eine Planung der Therapiesequenzen erforderlich. Die optimale Therapieabfolge ist nicht bekannt und sollte je nach individuellem Krankheitsverlauf und vorliegenden Komorbiditäten sowie den Nebenwirkungen der einzelnen Substanzen ausgewählt werden. Die Rolle neoadjuvanter und adjuvanter Therapien bleibt unklar. Systemic therapy of metastatic renal cell carcinoma has completely changed in the last 5 years. Although a cure for the disease is still not achieved with systemic treatment in the majority of cases immunotherapy is no longer used. The therapeutic regiments are mainly based on angiogenic inhibitors such as sunitinib, sorafenib, pazopanib, everolimus and temsirolimus as well as the combination of bevacizumab with interferon. This article gives an overview of these treatment options and the clinical setting for their usage. To achieve a prolonged progression-free survival, a continuous therapy based on the new drugs is necessary. The major goal of the treatment remains to keep the disease stable as complete remission is only seen in 2–4% of cases. With these lengthy treatment regimes a schedule for sequenced administration of drugs is necessary for most of the patients. The optimal treatment sequence is unknown and should be chosen based on the individual course of the disease and the side effects as well as comorbidities. The role of neoadjuvant and adjuvant therapies remains unclear. SchlüsselwörterNierenzellkarzinom-Sunitinib-Sorafenib-Pazopanib-Temsirolimus-Everolimus-Systemische Therapie KeywordsCarcinoma, renal cell-Sunitinib-Sorafenib-Pazopanib-Temsirolimus-Everolimus-Systemic therapy
    Der Urologe 01/2010; 49(12):1543-1552. · 0.46 Impact Factor
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    ABSTRACT: Target molecule Treatment (TMT) have emerged as the primary treatment in metastatic renal cell carcinoma. Majority of the patients in pivot trials were post nephrectomy cases. The benefit of cytoreductive nephrectomy in the era of TMT is debated. The role of these molecules in the adjuvant settings and in neo adjuvant/pre surgical role has evoked interest. In this review the different molecules used in the treatment of metastatic renal cancer and its effect on the primary renal tumour is discussed. Information available in the public domain about the presurgical/neoadjuvant targeted molecular treatment (TMT) is reviewed to understand the benefits and adverse effects of this modality of treatment. Sunitinib and sorafenib are the most commonly used and effective molecules in the neo adjuvant/re surgical treatment of renal cell carcinoma . Bevacizumab is less effective and has more chance of surgical complications in these settings mainly due to poor wound healing secondary to prolonged wash off period . The patent and the surgeon should be aware of the unpredictability and possible adverse effects before advising these molecule pre operatively. The response of the primary renal tumour to the target molecule is different from that of the metastatic tumour. The side effects of the molecules and its effect on the peri operative morbidity and mortality should also be considered when we advise these molecules as pre surgical/neo adjuvant treatment.
    Indian journal of surgical oncology. 06/2012; 3(2):114-9.
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    ABSTRACT: BACKGROUND: We report on a 62-year-old gentleman presenting at our urological department with an advanced renal cell cancer of the right kidney (10 cm in diameter), with an extensive caval vein thrombus (level IV) and bilateral pulmonary metastases. Another suspicious lesion at the left hemithorax was radiologically described. METHOD: A presurgical, neoadjuvant systemic therapy with sunitinib, a tyrosine kinase inhibitor, was initiated for 4 cycles in total (50 mg/day; 4 weeks on/2 weeks off). The cytoreductive nephrectomy was performed following the fourth cycle of sunitinib and after a 14-day break. Transesophageal echocardiography was used for intraoperative monitoring of the caval vein thrombus. Systemic treatment with sunitinib was continued 4 weeks after surgery. RESULTS: A significant reduction in tumor size, metastatic sites and down-staging of IVC from level IV to level III according to Novick classification was achieved. CONCLUSION: Significant down-staging of the tumor caval vein thrombus which initially reached the right atrium enabled us to perform surgery limited to the abdominal cavity without extracorporeal circulation nor hypothermia.
    World Journal of Urology 09/2012; · 2.89 Impact Factor