T-cell checkpoint inhibitors in metastatic renal cell carcinoma

The advent of checkpoint inhibitors has fostered great expectations for long-term outcome in cancer patients. Inhibitors of programmed death -1, programmed death ligand-1 and cytotoxic T-lymphocyte associated protein 4 are targets of contemporary cancer immunotherapy. Current phase III studies are ongoing and may define a novel treatment paradigm in metastatic renal cell carcinoma (mRCC). This review focuses on current clinical data in mRCC.

Nivolumab and ipilimumab are the most advanced checkpoint inhibitors in the field of mRCC. Current available data include phase I and randomized phase II trials, investigating single agent or combination therapies in mRCC, with objective responses in 20-52% of patients and 19-26 months overall survival in previously treated patients.

Immunotherapies have fostered great expectations on long-term overall survival in mRCC. As seen with previous cytokine treatment, long-term response is a key clinical outcome. Phase III data for previously treated patients are expected later this year and may define a novel standard for treatment. Combinational therapies have generated promising response data, indicating a potential role in treatment intensification in mRCC. Combination treatment is associated with ample toxicity, which might restrict this approach to selected patients. The major task for the future is to tailor immunotherapy for individual patients.