（4）臨床3：泌尿器科領域における分子標的薬の役割―腎細胞癌の薬物療法を中心に―

抄録

In urology, molecular-targeted therapies have been mainly used to treat advanced renal cell carcinoma (RCC). While the treatment for RCC is surgical resection, drug treatments can also be considered in cases of incurable or metastatic advanced RCC. Since the 1980s, cytokine therapy, such as the injection of interferon-α and interleukin-2, has been the main therapy for advanced RCCs. Individuals with RCC frequently overexpress vascular endothelial growth factor (VEGF), which is characterized by increased blood flow and angiogenesis. Because of the molecular characteristics of RCC, drug treatments targeting these molecules or their corresponding downstream signaling molecules have been researched and developed. In Japan, five types of multi-kinase inhibitors, including receptor tyrosine kinases and two types of mammalian target of rapamycin (mTOR) inhibitors, are currently being used.

Although these molecular-targeted therapies have more significant therapeutic effects than cytokine therapies, they have problems with adverse effects and drug resistance. Immune checkpoint inhibitors (ICI) related to the immune system in cancer pathogenesis were developed several years ago, and insurance coverage has been applied for advanced RCC in Japan since 2016. The usefulness of ICI combination therapies has been demonstrated in several clinical trials, and four types of ICI combination therapies have been approved as the first-line treatment for advanced RCC in Japan. Based on various guidelines, it is important to consider patient, tumor, and drug characteristics when selecting the appropriate drug treatment for advanced RCC.