转移性肾癌免疫治疗临床研究新进展

肾癌是泌尿系统常见的恶性实体肿瘤，其发病率逐年递增。对于早期肾癌，手术仍是最主要的治疗手段。而对于转移性肾癌（metastatic renal cell carcinoma，mRCC），需要以内科为主的多学科综合治疗，从而最大限度改善患者的生存期。过去十年间，多种血管内皮生长因子（vascular endothelial growth factor，VEGF）和mTOR 抑制剂已获得批准用于mRCC 的治疗，极大改善了患者的预后，但近年来应用上述药物带来的治疗获益已到达一个平台期，几乎所有患者最终出现耐药。随着新的免疫治疗的发展，免疫检查点抑制剂，特别是程序性死亡受体（programmed death- 1，PD- 1）/ 程序性死亡受体配体- 1（programmed death ligand1，PD-L1）抑制剂在转移性肾癌中取得显著疗效，进一步延长患者的生存期。与单药治疗相比，PD- 1/PD-L 1 抑制剂联合其他免疫治疗或抗VEGF等靶向治疗可减少肿瘤诱导的免疫耐受，有望进一步改善预后。

Advances in immunotherapy of metastatic renal cell carcinoma

Renal cell carcinoma is a common type of urinary solid tumor with increasing incidence. Surgery is the most important ther-apy for early stage tumors. Multidisciplinary therapy focused on internal medicine improves the survival of patients with metastatic re-nal cell carcinoma(mRCC). In the past decade, VEGF and mTOR inhibitors were approved for the treatment of mRCC. These treatments substantially prolonged patient survival. However, the clinical benefits of these agents have reached their limits. Almost each patient eventually developed resistance to VEGF and mTOR targeted therapies. Checkpoint inhibitors, such as PD-1/PD-L1 inhibitors, demon-strated an advantage in terms of the survival of mRCC patients with the development of novel immunotherapy agents. A combination of PD-1/PD-L1 inhibitors and other immunotherapy agents or VEGF-targeted agents may reduce the tumor-induced tolerance of the immune system and improve the prognosis of mRCC as compared with monotherapy.