Metastatik Böbrek Kanserine Yaklaşım
Özet
Renal hücreli karsinom (RHK), en yaygın görülen böbrek kanseri olup hastaların %25-30’u tanı anında metastatik evrededir. Metastatik RHK’de cerrahi rezeksiyon (sitoredüktif nefrektomi ve metastazektomi) uygun hastalarda sağkalımı olumlu etkiler. Akciğer, kemik, karaciğer ve beyin metastazlarında lokal cerrahi veya radyoterapi, embolizasyon gibi palyatif yöntemler tercih edilmektedir. Şeffaf hücreli RHK tedavisinde klasik kemoterapinin etkinliği kanıtlanmamışken, sistemik tedavide hedefe yönelik tedaviler (Tirozin Kinaz ve mTOR İnhibitörleri, monoklonal antikorlar) ve immünoterapi (IFN-α, IL-2, Nivolumab) ön plana çıkmaktadır. VHL gen inaktivasyonu mekanizmasına dayanan bu ajanlar, anjiogenezi baskılayarak progresyonsuz sağkalımı artırır. Birinci basamakta sunitinib, pazopanib, bevacizumab+IFN-α; ikinci basamakta ise axitinib, kabozantinib, lenvatinib+everolimus ve nivolumab gibi ilaçlar kılavuzlarda önerilmektedir. Şeffaf hücreli olmayan tiplerde ise net bir tedavi modeli bulunmamaktadır.
Renal cell carcinoma (RCC) is the most common type of kidney cancer, and 25-30% of patients present with metastatic disease at the time of diagnosis. In metastatic RCC, surgical resection (cytoreductive nephrectomy and metastasectomy) positively impacts survival in appropriate patients. Local surgery or palliative methods such as radiotherapy and embolization are preferred for lung, bone, liver, and brain metastases. While the efficacy of conventional chemotherapy has not been proven in clear cell RCC, systemic treatment focuses on targeted therapies (Tyrosine Kinase and mTOR Inhibitors, monoclonal antibodies) and immunotherapy (IFN-α, IL-2, Nivolumab). These agents, based on the mechanism of VHL gene inactivation, increase progression-free survival by suppressing angiogenesis. Drugs such as sunitinib, pazopanib, and bevacizumab+IFN-α are recommended in the first-line setting, whereas axitinib, cabozantinib, lenvatinib+everolimus, and nivolumab are preferred in the second-line setting. There is still no established treatment model for non-clear cell metastatic RCC.
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