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Takahiro Osawa, Ario Takeuchi, Takahiro Kojima, Nobuo Shinohara, Masatoshi Eto, Hiroyuki Nishiyama, Overview of current and future systemic therapy for metastatic renal cell carcinoma, Japanese Journal of Clinical Oncology, Volume 49, Issue 5, May 2019, Pages 395–403, https://doi.org/10.1093/jjco/hyz013
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Abstract
Since the 2000s, there have been dramatic advances in the treatment of metastatic renal cell carcinoma (mRCC), including drugs targeting vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways. The first VEGF inhibitors approved for mRCC were sorafenib and sunitinib. Subsequently, two mTOR inhibitors (everolimus and temsirolimus) and other VEGF inhibitors (pazopanib and axitinib) were approved. Overall survival (OS) of mRCC patients has significantly increased during this period.
Two novel VEGF inhibitors have recently been approved overseas, including cabozantinib and lenvatinib. Additionally, the recent advent of immunotherapy with checkpoint inhibitors has led to significant changes in the treatment of mRCC. The PD-1 inhibitor nivolumab improved the OS rate of patients with mRCC following VEGF inhibitors. Moreover, the CheckMate 214 trial demonstrated the benefit of nivolumab plus ipilimumab combination therapy in OS and objective response rate in treatment-naive intermediate- and poor-risk mRCC. In this review, current evidence related to the clinical use of targeted therapies and checkpoint inhibitors for the treatment of patients with mRCC is discussed. In addition, we review ongoing trials investigating combinations of checkpoint inhibitors with targeted agents and the identification of biomarkers to guide patient selection and enable individualization of therapy.
- vascular endothelial growth factor a
- biological markers
- renal cell carcinoma
- combined modality therapy
- immunotherapy
- neoplasm metastasis
- systemic therapy
- everolimus
- sunitinib
- sorafenib
- temsirolimus
- mtor serine-threonine kinases
- renal cell carcinoma metastatic
- axitinib
- ipilimumab
- pazopanib
- mtor inhibitors
- therapy naive
- molecular targeted therapy
- cabozantinib
- nivolumab
- vascular endothelial growth factor inhibitors
- lenvatinib
- immune checkpoint inhibitors
- pd-1 inhibitors