Welche Bedeutung hat die Immuntherapie beim metastasierten Nierenzellkarzinom nach Einführung der neuen Target-Substanzen in Deutschland: Ergebnisse einer repräsentativen Umfrage der DGFIT

Introduction:Until recently, the standard therapy for metastatic renal cell carcinoma (mRCC) in Germany consisted of interleukin-2 (IL-2), interferon-alfa (IFN) as single agents or in combination, with or without chemotherapy. Since 2005, new drugs (target drugs) in the therapy for mRCC are avaible. The aim of this study was to analyse the current therapy standard in Germany. Methods:By representative telephone interviews (GFK-Nürnberg by order of DGFIT) the following colleagues were contacted A:urologists in private practice (n=40), B:oncologists in private practice (n=40), C:hospital urologists (n=35) and D:hospital oncologists (n=35). Screening criteria were 1)responsibility for therapy in mRCC; 2)therapy of at least 10patients with mRCC per year. Results:Patiens/year: A:n=19, B:n=17, C:n=43, D:n=21. 98% of patients with mRCC were treated: A:the most frequent therapy was sunitinib(43%, 42%, 33% as first-, second-, third-line), B:the most frequent therapy was sunitinib (45% as first-line, 37% as second-line), the most frequent third-line therapy was sorafenib (35%); C:the most frequent therapy were sorafenib and sunitinib (first-line 26% vs. 27%, second-line 46% vs. 42%), in third-line therapy additionally temsirolimus 24%; D:primary sorafenib and sunitinib (first-line 33% vs. 40%, second-line 46% vs. 42%), in third-line therapy additionally temsirolimus 23%. Immunotherapy (IL-2, IFN with or without chemotherapy) in mRCC plays in Germany for the second- and third-line therapy in AD no major role (less than 10%). Otherwise, for first-line therapy immunotherapy has some relevance: A:25%, B:37%, C:33%, D:16%. The most important criteria for therapy decision making in AD were: efficacy, toxicity, drug approval status. Conclusions:Most patients with mRCC in Gerany were seen by hospital urologists. Sunitinib (in first-line) and sorafenib (in second-line) are currently the most frequent prescribed drugs in mRCC. Temsirolimus is used mostly for third-line therapy (followed by sunitinib/sorafenib). Treatment of mRCC in Germany is increasingly being performed by oncologists.