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

Abstract

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.

• Authors: Yann-Alexandre Vano, Sylvain Ladoire, Réza Elaidi, Slimane Dermeche, Jean-Christophe Eymard, Sabrina Falkowski, Marine Gross-Goupil, Gabriel Malouf, Bérangère Narciso, Christophe Sajous, Sophie Tartas, Eric Voog, Alain Ravaud
• Journal: Cancers (Cancers (Basel)) Vol. 13 Issue 21 (Nov 05 2021) ISSN: 2072-6694 [Print] Switzerland
• PMID: 34771710 (Publication Type: Journal Article, Review)