Over the last 10 years, the capacities of second-line systemic therapy for metastatic renal cell carcinoma (mRCC) changed significantly. Targeted therapy is a standard treatment for patients with mRCC. However, the choice of therapeutic agents for such patients remains challenging. In the absence of reliable prognostic biomarkers, physicians can use only the results of randomized clinical trials and their own routine experience with targeted drugs when choosing a regimen of second-line therapy. The article discusses the current situation with second-line therapy with the three new options available for patients with mRCC. It also contains a case report, describing our successful experience of treatment a female patient that received 6 variants of chemotherapy with good effect during 89 months after the diagnosis.
This article presents a systematic literature review to assess the survival outcomes of patients with bilateral renal cell carcinoma who underwent nephro-preserving surgery. Patients with bilateral renal neoplastic lesions represent a rare subpopulation, numbering, according to different authors, from 2 to 6 % of the total RCC group. Despite the increase in the number of cases of bilateral RCC, the number of works devoted to the study of the features of surgical intervention, prognosis factors, treatment outcomes and survival of this cohort of patients is limited, and a number of important questions regarding this problem remain unresolved. Currently, the only effective method of treating bilateral renal cancer is nephro-preserving surgery in the volume of bilateral renal resection / nephrectomy with resection of the contralateral kidney in case of synchronous lesion or resection of a single kidney in case of metachronous lesion. This strategy avoids or reduces the risk of developing renal failure and its consequences after surgery. Conclusion. Nephro-preserving surgery for bilateral renal cell carcinoma is the only effective method to achieve satisfactory oncological results with a low incidence of complications.
В статье представлены данные проведенных клинических исследований с применением сунитиниба с расширенными критериями включения и нерандомизированных исследований, в которых доказана клиническая эффективность сунитиниба у больных с неблагоприятным прогнозом течения заболевания, несветлоклеточными вариантами мПКР, метастазами в головном мозге, у пожилых пациентов и больных с терминальной стадией почечной недостаточности, нуждающихся в гемодиализе. Несмотря на меньшие показатели частоты объективных ответов, выживаемость без прогрессирования у данной категории больных по сравнению с пациентами со светлоклеточным мПКР оказалась сопоставимой, а общая выживаемость чуть ниже, чем в регистрационном рандомизированном клиническом исследовании.
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