First-Line Treatment of Metastatic Clear Cell Renal Cell Carcinoma: What Are the Most Appropriate Combination Therapies?

Fiche publication

Date publication

novembre 2021

Journal

Cancers

Auteurs

Membres identifiés du Cancéropôle Est :
Dr EYMARD Jean-Christophe , Dr LADOIRE Sylvain , Pr MALOUF Gabriel

Tous les auteurs :
Vano YA, Ladoire S, Elaidi R, Dermeche S, Eymard JC, Falkowski S, Gross-Goupil M, Malouf G, Narciso B, Sajous C, Tartas S, Voog E, Ravaud A

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/34771710

Résumé

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.