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Abstract(s)
Introdução: O carcinoma de células renais é considerado uma das neoplasias urológicas
mais letais, quimio e radioresistente, e apenas é curada por abordagem cirúrgica nas fases
de doença localizada. Os doentes com avanço local do tumor e metástases sempre tiveram
tratamento extremamente limitado, o que se refletiu na mortalidade elevada associada ao
tumor. Com o uso rotineiro, nos últimos anos, das técnicas de imagem, o carcinoma de
células renais tem sido diagnosticado de forma incidental, pois manifesta-se tardiamente
na sua evolução, o que levou a um aumento considerável da sua incidência. Com o avançar
dos tempos e após pesquisas sobre as características do carcinoma de células renais, a
terapêutica sistémica evoluiu de forma drástica, trazendo abordagens menos invasivas e
com impacto na sobrevida global dos doentes. Nesta dissertação serão abordadas as
terapêuticas sistémicas que surgiram nos últimos anos, as que se mantêm em estudo, como
têm alterado a evolução natural da doença e as repercussões na prática clínica.
Metodologia: Pesquisa bibliográfica em plataformas online com análise de artigos entre
2000 e 2020.
Resultados: Da avaliação dos dados recolhidos destaca-se que os novos fármacos
aprovados e recomendados para o tratamento do carcinoma de células renais foram
desenvolvidos com base nas vias moleculares e nas características genéticas do tumor.
Surgiram agentes dirigidos a determinadas moléculas e agentes moduladores do
microambiente imunológico do tumor. É de realçar que a imunoterapia teve e continua a
ter um importante papel nesta evolução terapêutica e que, apesar de apenas nos últimos
anos terem surgido fármacos mais potentes, foi pioneira com a introdução das citocinas
inespecíficas. Os ensaios clínicos deixaram algumas questões na aplicação dos fármacos,
como tempo de tratamento ideal, definição de estratégias de tratamento e seleção de
doentes responsivos. O desenvolvimento de biomarcadores preditivos de resposta à
terapêutica instituída e de prognóstico será imprescindível para preencher as lacunas
deixadas pelos ensaios até agora desenvolvidos.
Conclusão: A evolução da terapêutica sistémica do carcinoma de células renais mudou o
curso natural da doença. Porém, permanece uma doença incurável, a não ser por
nefrectomia nos casos de doença localizada e, por isso, será necessária uma continua
estruturação da abordagem ideal de tratamento.
Introduction: Renal cell carcinoma is considered one of the most lethal, chemo and radioresistant urological neoplasms, and is only cured by surgical approach in localized disease. Patients with local tumor advancement and metastases have always had extremely limited treatment, which was reflected in the high mortality associated with the tumor. With the routine use of imaging techniques in recent years, renal cell carcinoma has been diagnosed incidentally, as it manifests itself late in its evolution, which has led to a considerable increase in its incidence. With the advancement of time and after research on the characteristics of renal cell carcinoma, systemic therapy has evolved drastically, bringing less invasive approaches with an impact on the overall survival of patients. In this dissertation, the systemic therapies that emerged in recent years will be addressed, those that are still under study, as they have altered the natural evolution of the disease and the repercussions in clinical practice. Methodology: Bibliographic research on online platforms with analysis of articles between 2000 and 2020. Results: From the evaluation of the collected data, it is highlighted that the new drugs approved and recommended for the treatment of renal cell carcinoma were based on the molecular pathways and the genetic characteristics of the tumor. Agents that target specific molecules and modulate the tumor immune microenvironment have emerged. It should be noted that immunotherapy has had and continues to have a major role in this therapeutic evolution and that, although only in the last few years more powerful drugs have appeared, it was a pioneer in the introduction of nonspecific cytokines. Clinical trials have left some questions in the application of drugs, such as an ideal treatment time, definition of treatment strategies and selection of responsive patients. The development of predictive biomarkers of response to instituted therapy and prognosis will be essential to fill the gaps left by the trials developed so far. Conclusion: The evolution of systemic therapy for renal cell carcinoma has changed the natural disease course. However, it remains an incurable disease, except for nephrectomy in local cases and, therefore, continuous structuring of the ideal treatment approach will be necessary.
Introduction: Renal cell carcinoma is considered one of the most lethal, chemo and radioresistant urological neoplasms, and is only cured by surgical approach in localized disease. Patients with local tumor advancement and metastases have always had extremely limited treatment, which was reflected in the high mortality associated with the tumor. With the routine use of imaging techniques in recent years, renal cell carcinoma has been diagnosed incidentally, as it manifests itself late in its evolution, which has led to a considerable increase in its incidence. With the advancement of time and after research on the characteristics of renal cell carcinoma, systemic therapy has evolved drastically, bringing less invasive approaches with an impact on the overall survival of patients. In this dissertation, the systemic therapies that emerged in recent years will be addressed, those that are still under study, as they have altered the natural evolution of the disease and the repercussions in clinical practice. Methodology: Bibliographic research on online platforms with analysis of articles between 2000 and 2020. Results: From the evaluation of the collected data, it is highlighted that the new drugs approved and recommended for the treatment of renal cell carcinoma were based on the molecular pathways and the genetic characteristics of the tumor. Agents that target specific molecules and modulate the tumor immune microenvironment have emerged. It should be noted that immunotherapy has had and continues to have a major role in this therapeutic evolution and that, although only in the last few years more powerful drugs have appeared, it was a pioneer in the introduction of nonspecific cytokines. Clinical trials have left some questions in the application of drugs, such as an ideal treatment time, definition of treatment strategies and selection of responsive patients. The development of predictive biomarkers of response to instituted therapy and prognosis will be essential to fill the gaps left by the trials developed so far. Conclusion: The evolution of systemic therapy for renal cell carcinoma has changed the natural disease course. However, it remains an incurable disease, except for nephrectomy in local cases and, therefore, continuous structuring of the ideal treatment approach will be necessary.
Description
Keywords
Carcinoma de Células Renais Carcinoma Renal Erapêutica Sistémica Evolução Terapêutica Neoplasia Renal