Jennifer Knox， MD

加拿大玛格丽特公主癌症中心

　　热点一：靶向治疗临床数据分析

　　本届论坛对转移性肾癌一线和二线治疗的临床试验数据进行了讨论，迄今为止最强有力的证据支持是舒尼替尼或培唑帕尼（帕唑帕尼）用于肾癌一线治疗。舒尼替尼与培唑帕尼的头对头研究表明，二者疗效相当，但是强烈的迹象显示培唑帕尼的耐受性可能更好。

　　更具争议性的是，患者一线治疗失败后，应选择哪种二线治疗药物。有随机试验数据显示，依维莫司二线治疗是有效的。此外，与会专家们也分享了自己临床工作中的经验性选择，尽管没有充分的循证医学证据支持。

　　热点二：肾细胞癌转移瘤

　　当今治疗肾癌的一个真正挑战是肿瘤转移。目前可获得的大多数药物可能对某些特定部位的肿瘤有效，当肿瘤转移至身体其他部位时，疗效可能会降低，因而给患者造成了极大的疾病负担。因为目前可供选择的治疗方案有限，所以临床医生应结合患者个体情况，尽可能寻求最佳治疗策略，使仅有的药物发挥最大疗效。

　　热点三：全程管理

　　肾癌的全程管理也是本届论坛讨论的热点问题。什么时候开始药物治疗，什么时候应该停药，什么时候应该进行局部治疗（如放疗或手术），什么时候应重新开始药物治疗？论坛讲者和讨论组专家提出了比较好的治疗建议，应该在多学科的指导下，对患者实施全程管理，实现个体化治疗，而不是仅仅因为药物在某些方面的可能疗效和患者状态较好就片面地认为治疗选择是最佳的。

　　热点四：免疫治疗

　　会上，专家们介绍了免疫治疗领域有望上市的药物及其效果，并就如何支付价格昂贵的免疫治疗药物提出了建议。Jennifer Knox教授：“虽然目前还没有临床试验数据，但免疫治疗到来之势不可挡，这令人非常兴奋。”

访谈原文

　　Oncology Frontier:You were on the panel for the discussion on sequential and combination therapies， when to treat， how long to treat and when to stop. Can you give us an overview of the subject?

　　Dr. Knox: We had a lot of discussion today about the clinical trial data that we have for treating metastatic kidney cancer in both the first-line and second-line setting.

　　The strongest data so far is for sunitinib or pazopanib in the first-line setting. On head-to-head comparisons they appear equivalent and there may be strong indications that pazopanib is better tolerated.

　　In the second-line setting once a patient has progressed on those drugs (unfortunately patients develop resistance)， there is a little more controversy over what to use next. We have randomized data to suggest Afinitor (everolimus， a different class of drug) is effective and we also have randomized data to suggest a similar drug to the first-line drugs， axitinib， is also effective.

　　I think a lot of the discussion today was to hear different people’s experiences with when to choose one over another， but the data really supports either choice.

　　Oncology Frontier: What are some of the other hot topics in RCC discussed at the meeting?

　　Dr. Knox: There were a lot of hot topics discussed. A real challenge with treating kidney cancer today is that these patients have a large burden of disease with metastases to different parts of the body. These drugs may be very effective in some areas， but then the disease starts to grow in others. Given that we don’t have a lot of options， we seek out the best strategy to maximize the use of drugs.

　　Many of the discussions we had in the hot topics related to when we would stop， when we would do localized therapy like radiation or surgery to progressing metastases and then go back to continuing with drug therapy. Most of the experts present and those on the panel favor that kind of approach rather than throwing a drug out that may still be effective for some of the disease as long as the patient is well.

　　We also talked quite a bit about the immunotherapy drugs that are coming and how effective they will be and how will the world pay for them because they are very expensive and how durable they will be. We don’t have that data yet， but it is coming and that is very exciting.