title: [Systemic treatment of metastatic renal cell carcinoma: change of paradigms after introduction of targeted therapy].
abstract: BACKGROUND
  The goal of this work was to describe the change of treatment paradigms for metastatic renal cell carcinoma (mRCC) since 2006.
  
  
  METHODS
  We retrospectively investigated all mRCC patients who were treated with targeted therapy between June 2006 and June 2012 at the University of Münster.
  
  
  RESULTS
  In all, 50 of 158 (31.6 %) patients were initially treated with immunotherapy. The most often used second line treatment after immunotherapy was sorafenib (29 patients, 58.0 %). The first line treatment chosen for therapy-naïve patients was sunitinib (68 patients, 63.0 %). There was no statistically significant difference between the two groups (572 vs. 554 days, p = 0.745). A total of 77 patients had synchronous metastasis (48.8 %), 55 of whom underwent cytoreductive nephrectomy. There was a significant survival benefit in favor of surgically treated patients (510 vs. 186 days, p = 0.002).
  
  
  CONCLUSIONS
  After introduction of the new agents treatment paradigms have changed substantially. Immunotherapy is used only rarely. Cytoreductive nephrectomy may continue to be regarded as standard treatment until prospective data are available.
authors.affiliation: Klinik für Urologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48149, Münster, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Papavassilis
authors.forename: L M
authors.initials: LM
authors.lastname: Krabbe
authors.forename: B
authors.initials: B
authors.lastname: Thielen
authors.forename: M
authors.initials: M
authors.lastname: Bögemann
authors.forename: R
authors.initials: R
authors.lastname: Moritz
authors.forename: I
authors.initials: I
authors.lastname: Hoffmeister
authors.forename: L
authors.initials: L
authors.lastname: Hertle
authors.forename: E
authors.initials: E
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D000077210:Sunitinib; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077210:Sunitinib
vernacular_title: Systemische Behandlung des metastasierten Nierenzellkarzinoms: Paradigmenwechsel nach Einführung der zielgerichteten Therapie.