VEGFR-TKIs ± IOと骨薬で治療された転移性RCCにおける薬剤関連骨縮症:現実世界の分析
Marco Stellato1, Ernesto Zecca2, Paola Bracchi2
1Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Tumori
|August 29, 2025
まとめ
腎臓細胞がんの骨転移は 課題となる. VEGFR- TKIsと併用した骨を標的とする治療は,薬剤による骨縮症のリスクを増加させるが,免疫腫瘍学による併用はそうではない.
科学分野:
- 腫瘍学
- 薬理学について
- 腎臓科
背景:
- 骨転移 (BM) は転移性腎臓細胞癌 (mRCC) の重大な合併症であり,骨格関連イベント (SREs) に繋がります.
- デノスマブやゾレドロン酸のような骨を標的とした治療法 (BTT) は,SREの管理に使用されますが,薬剤関連の骨縮症 (MRONJ) のリスクがあります.
- BTTと血管内皮成長因子受容体チロシンキナーゼ阻害剤 (VEGFR- TKI) の併用は,MRONJのリスクをさらに高めることがあります.
研究 の 目的:
- 特にVEGFR-TKIsおよび/または免疫腫瘍学 (IO) 療法と併用したBTTで治療されたmRCC患者におけるMRONJの発生率を評価する.
- この患者集団におけるMRONJ発症に関連する危険因子と臨床的特徴を分析する.
- 異なる治療組合の間で MRONJ 率を比較する.
主な方法:
- 2013年1月から2025年1月までの間にBTT (デノスマブまたはゾレドロン酸) で治療されたmRCC患者104人を対象とした遡及コホート研究.
- データ収集には,患者の人口統計,治療法 (IO,VEGFR- TKI,BTT),およびMRONJの発生が含まれていました.
- MRONJの診断時点でのBTT被曝期間と併用治療の分析
主要な成果:
- BTTを投与した患者の11. 5% (12/ 104) がMRONJを発症し,BTT被曝期間の中央値は13. 8ヶ月であった.
- MRONJの診断時に,12人のうち10人がVEGFR- TKI治療を受けている.
- 特に,BTTと共にIO- IOまたはIO- TKIを併用した患者では,MRONJの症例は観察されなかった.
結論:
- VEGFR- TKIsとBTTで治療されたmRCC患者におけるMRONJの発生率は,以前の報告と一致しています.
- VEGFR- TKIsとBTTの併用は,MRONJの重要な危険因子であるようです.
- VEGFR- TKIsとBTTと併用した免疫腫瘍学療法はこのコホートでMRONJのリスクを増加させるようには見えませんでした.
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