Recent advances in the frontline treatment of metastatic renal cell carcinoma

• 作者: Camillo Porta Mimma Rizzo
• 来源期刊: 癌症转移与治疗（英文版）
• 年，卷（期）: 2021,（7）
• 所属期刊栏目: Review
• 页码范围: 23-34
• 页数: 12页
• 语种: 英文
• DOI: 10.20517/2394-4722.2021.86

摘要

We aim to describe the most recent advances in the upfront treatment of metastatic renal cell carcinoma, and to provide criteria - though often subjective - which could be used for treatment selection, by means of a critical review of the results of novel trials of immune-based combinations, coupled with personal considerations and experiences. To date, 5 immune-based combinations have been tested within large phase Ⅲ trials; four of them yielded a significant overall survival benefit (Ipilimumab + Nivolumab, Pembrolizumab + Axitinib, Nivolumab + Cabozantinib and Pembrolizumab + Lenvatinib), while the combination of Avelumab + Axitinib, although reaching study primary endpoint, determined just a significant progression-free survival benefit. In terms of safety, the excess of adverse events is overall counterbalanced to the higher activity of the combinations. Overall, all the discussed immune-based combinations were ultimately approved by different regulatory authorities, and are indeed included in the most important international guidelines. Waiting for longer follow-ups and more mature trial data, as well as for real-world experiences, in the absence of validated biomarkers, our 1st line treatment choice cannot but rely on methodologically incorrect treatment comparisons, personal preferences, and experience.