Metastatik renal hücreli kanser tedavisinde tirozin kinaz inhibitörlerinin etki ve yan etkisinin retrospektif değerlendirilmesi
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Date
2018
Authors
Şahin, Abdülkadir
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Renal Hücreli Karsinom (RHK) tüm kanserlerin %2-3'lük kısmını oluşturmaktadır. RHK, böbrek içinde en sık gelişen kitlesel lezyondur. Klinik olarak sessiz ilerleyen ve yüksek oranda metastatik seviyede tespit edilen renal hücreli kanserlerde tedavi seçeneklerinin sırası ve etkisi yapılan araştırmalarla önem kazanmaktadır. Lokalize RHK için cerrahi genellikle tedavi edicidir. Cerrahi prosedür, hastanın yaş, komorbiditesi, hastalığın yayılımına bağlı olarak radikal veya parsiyel nefrektomiyi içerebilir. Rezektabl tümör ve eşlik eden tek metastazı olan seçilmiş hastalarda metastaz rezeksiyonu ile birlikte olan radikal nefrektomi küratif olabilir. Cerrahi adayı olmayan göreceli küçük renal kitleli olan hastalarda diğer ablatif tedaviler seçenek olabilir (kriyoterapi, radyofrekans ablasyon) . Tanı anında %20-30, takiplerinde %20-40 oranında metastaz saptanan RHK'larının ülkemizde ilk basamak tedavisi interferon alfa olarak uygulansa da genellikle sonrasında progresyon gözlenen hastalarda, tirozin kinaz inhibitörleri (TKI) , vasküler endotelyal growth faktör (VEGF) yolu ve rapamisin protein kompleksinin mekanistik hedefi (m TOR) inhibisyonuyla geliştirilen tedavilerin daha etkin olduğu gösterilmiştir. VEGF yolunun blokajı iki yolaktan gerçekleşmektedir, bu yolları kullanan ajanlar; VEGF reseptörünün intrasellüler parçasını bloke eden küçük molekül TKI'lar (sunitinib, pazopanib, cabozantinib, axitinib, sorafenib), VEGF reseptörüne bağlanmayı engelleyen, dolaşan VEGF'ye bağlanan monoklonal antikorlardır (bevacizumab). Bu çalışmanın amacı; merkezimizdeki 01.12.2010 - 30.04.2018 arasında RHK tanısı almış ve tirozin kinaz inhibitörü kullanan 65 hastada, tirozin kinaz inhibitörlerinin etki ve yan etkisinin değerlendirilmesidir. Sonuç olarak, mRHK sunitinib ve pazopanip tedavisi için literatüre benzer sağkalım sonuçlarına rastlandı. Yan etki profili olarak; halsizlik, hipertansiyon, dermatit, mukozit, bulantı, diyare, hipotiroidi gözlendi.
Renal cell carcinoma (RCC) accounts for 2-3% of all cancers. RCC is the most common massive leuconium in the kidney. In renal cell carcinomas with clinically silent progression and at high metastatic levels, the order and effect of the treatment options gain importance. Surgery for localized RCC is usually curative. The surgical procedure may involve radical or partial nephrectomy depending on the age, comorbidity, and extent of disease in the patient. In selected patients with resectable tumor and concomitant single metastasis, radical nephrectomy with metastatic resection may be curative. Other ablative therapies may be an option in patients with relatively small renal masses without surgical candidates (cryotherapy, radiofrequency ablation). In patients with RCC who have metastasized 20-30% at the time of diagnosis and 20-40% of follow-up, they are treated with interferon alpha as the first line therapy in our country, and in patients with progression usually followed by tyrosine kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) pathway and rapamycin (mTOR) of the protein complex has been shown to be more effective. Blockage of the VEGF pathway occurs in two ways; Small molecule TKIs (sunitinib, pazopanib, cabozantinib, axitinib, sorafenib) that block the intracellular part of the VEGF receptor are monoclonal antibodies (bevacizumab) that bind to circulating VEGF, which prevents binding to the VEGF receptor. The purpose of this study is; to evaluate the efficacy and side effects of tyrosine kinase inhibitors in 65 patients with RCC diagnosed and using a tyrosine kinase inhibitor between 01.12.2010 - 30.04.2018 in our center. As a result, we found similar survival results for the treatment of mRCC sunitinib and pazopanip. As side effect profile; fatigue, hypertension, dermatitis, mucositis, nausea, diarrhea, hypothyroidism were observed.
Renal cell carcinoma (RCC) accounts for 2-3% of all cancers. RCC is the most common massive leuconium in the kidney. In renal cell carcinomas with clinically silent progression and at high metastatic levels, the order and effect of the treatment options gain importance. Surgery for localized RCC is usually curative. The surgical procedure may involve radical or partial nephrectomy depending on the age, comorbidity, and extent of disease in the patient. In selected patients with resectable tumor and concomitant single metastasis, radical nephrectomy with metastatic resection may be curative. Other ablative therapies may be an option in patients with relatively small renal masses without surgical candidates (cryotherapy, radiofrequency ablation). In patients with RCC who have metastasized 20-30% at the time of diagnosis and 20-40% of follow-up, they are treated with interferon alpha as the first line therapy in our country, and in patients with progression usually followed by tyrosine kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) pathway and rapamycin (mTOR) of the protein complex has been shown to be more effective. Blockage of the VEGF pathway occurs in two ways; Small molecule TKIs (sunitinib, pazopanib, cabozantinib, axitinib, sorafenib) that block the intracellular part of the VEGF receptor are monoclonal antibodies (bevacizumab) that bind to circulating VEGF, which prevents binding to the VEGF receptor. The purpose of this study is; to evaluate the efficacy and side effects of tyrosine kinase inhibitors in 65 patients with RCC diagnosed and using a tyrosine kinase inhibitor between 01.12.2010 - 30.04.2018 in our center. As a result, we found similar survival results for the treatment of mRCC sunitinib and pazopanip. As side effect profile; fatigue, hypertension, dermatitis, mucositis, nausea, diarrhea, hypothyroidism were observed.
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Keywords
Metastatik renal hücreli kanser, Tirozin kinaz inhibitörü, Prognostik faktörler, Metastatic renal cell carcinoma, Tyrosine kinase inhibitor, Prognostic factors
Citation
Şahin, A. (2018). Metastatik renal hücreli kanser tedavisinde tirozin kinaz inhibitörlerinin etki ve yan etkisinin retrospektif değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.