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Recent advances in the frontline treatment of metastatic renal cell carcinoma

Journal of Cancer Metastasis and Treatment 2021年第1期7卷 695-706页

作者： Camillo Porta mimma rizzo Department of Biomedical Sciences and Human Oncology University of Bari‘A.Moro’Bari 70124Italy Division of Medical Oncology A.O.U.Consorziale Policlinico di BariBari 70124Italy Division of Translational Oncology I.R.C.C.S.Istituti Clinici Scientifici MaugeriPavia 27100Italy

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 *** 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 *** terms of safety,the excess of adverse events is overall counterbalanced to the higher activity of the ***,all the discussed immune-based combinations were ultimately approved by different regulatory authorities,and are indeed included in the most important international *** 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.

关键词： Renal cell carcinoma immune checkpoint inhibitors antiangiogenics survival

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Clinical resistance predictors to first-line VEGFR-TKI monotherapy for metastatic renal cell carcinoma: a retrospective multicenter real-life case series

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Journal of Cancer Metastasis and Treatment 2023年第1期9卷 445-458页

作者： Gaetano Pezzicoli Silvana Quaglini Valentina Tibollo Melissa Bersanelli Camillo Porta mimma rizzo Department of Interdisciplinary Medicine University of Bari"Aldo Moro"Bari 70124Italy Department of Electrical Computer and Biomedical EngineeringUniversity of PaviaPavia 27100Italy Laboratory of Informatics and Systems Engineering for Clinical Research Scientific Clinical Institute Maugeri(ICS Maugeri)Pavia 27100Italy Medical Oncology Unit University Hospital of ParmaParma 43121Italy Division of Translational Oncology Scientific Clinical Institute Maugeri(ICS Maugeri)Pavia 27100Italy Medical Oncology Unit University Hospital-Polyclinic of BariBari 70124Italy

Aim:For many years,systemic treatment of metastatic Renal Cell Carcinoma(mRCC)was based on sequential targeted agent *** this real-life case series,we evaluated easily accessible clinical factors useful for disease course ***:We exploited patients'clinical pathological characteristics and systemic treatment outcomes in a real-world population of 365 mRCC patients who received sequential monotherapies in the targeted therapy era,and we identified an early progressors subpopulation,resistant to first-line VEGFR-TKI monotherapy in less than 6 ***:Early progressors(n=124)show a far worse OS compared with patients progressing beyond the sixth month of therapy(13.5 vs.44.8 months,P-value<0.0001,HR=0.41,95%CI:0.29-0.53).However,these patients did not show far worse performance in second and third-line settings compared to first-line *** the univariate analysis,IMDC risk class,sarcomatoid features,and Systemic Inflammation Index(SII)were correlated with first-line therapy Progression-Free Survival(PFS1).In multivariate analysis,variables correlated with first-line outcome were IMDC risk class,histotype,and number of metastatic sites at the ***:Real-world data can contribute to developing easy-to-use prognostic factors associated with refractory disease that could support clinicians in identifying the most appropriate treatment strategy for each patient.

关键词： Renal cell carcinoma targeted therapy tyrosine kinase inhibitor drug resistance early progressor rapidly progressive prognostic factor real-world data

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