First-Line Treatment of Metastatic Clear Cell Renal Cell Carcinoma: What Are the Most Appropriate Combination Therapies?
Yann-Alexandre VanoSylvain LadoireRéza ElaidiSlimane DermecheJean-Christophe EymardSabrina FalkowskiMarine Gross-GoupilGabriel MaloufBérangère NarcisoChristophe SajousSophie TartasEric VoogAlain RavaudPublished in: Cancers (2021)
The development of antiangiogenic treatments, followed by immune checkpoint inhibitors (ICI), has significantly changed the management of metastatic clear cell renal cell cancer. Several phase III trials show the superiority of combination therapy, dual immunotherapy (ICI-ICI) or ICI plus tyrosine kinase inhibitors (TKI) of the vascular endothelium growth factor (VEGF) over sunitinib monotherapy. The question is therefore what is the best combination for a given patient? A strategy based on the International Metastatic Database Consortium (IMDC) classification is currently recommended with pembrolizumab + axitinib, cabozantinib + nivolumab, and lenvatinib + pembrolizumab (for all patients) or nivolumab + ipilimumab (for patients with intermediate or poor risk), which are the first-line treatment standards of care. However, several issues remain unresolved and require further investigation, such as the PD-L1 status, the relevance of possible options based on the patient's profile, and consideration of second-line and subsequent treatments.
Keyphrases
- combination therapy
- growth factor
- phase iii
- squamous cell carcinoma
- small cell lung cancer
- end stage renal disease
- metastatic renal cell carcinoma
- advanced non small cell lung cancer
- open label
- case report
- healthcare
- ejection fraction
- newly diagnosed
- chronic kidney disease
- clinical trial
- single cell
- clear cell
- palliative care
- deep learning
- randomized controlled trial
- tyrosine kinase
- endothelial cells
- peritoneal dialysis
- cell therapy
- prognostic factors
- patient reported outcomes
- stem cells
- pain management
- adverse drug
- chronic myeloid leukemia
- quality improvement
- young adults
- renal cell carcinoma
- lymph node metastasis