Immunotherapy for metastatic renal cell carcinoma

Area of Science:

• Oncology
• Immunotherapy
• Renal Cell Carcinoma

Background:

• Metastatic renal cell carcinoma (mRCC) treatment has shifted towards targeted therapies.
• Current guidelines favor targeted agents like sunitinib and pazopanib, with cytokines as alternatives.
• Nivolumab, a PD-1 inhibitor, was approved in 2015 as a targeted immunotherapy for previously treated mRCC.

Purpose of the Study:

• To evaluate the efficacy of immunotherapies, alone or combined with targeted therapies, for metastatic renal cell carcinoma.
• To assess treatment effects on patient benefit and outcomes.

Main Methods:

• Systematic search of multiple databases (Cochrane Library, MEDLINE, Embase, Web of Science) and clinical trial registers.
• Inclusion of randomized controlled trials (RCTs) and quasi-RCTs for mRCC patients.
• Analysis of summary statistics (risk ratios, mean differences) and quality of evidence using GRADE methodology.

Main Results:

• Interferon-alpha (IFN-α) monotherapy likely increases mortality and adverse events compared to standard targeted therapies.
• IFN-α combined with targeted therapies showed no significant difference in mortality but may increase adverse events.
• Targeted immunotherapy (nivolumab) demonstrated reduced mortality, improved quality of life, and fewer adverse events compared to everolimus in previously treated patients.

Conclusions:

• Moderate-quality evidence suggests IFN-α monotherapy increases mortality, while combination therapy shows no mortality difference but increased adverse events.
• Low-quality evidence indicates IFN-α alone worsens quality of life and increases severe adverse events.
• Moderate-quality evidence supports targeted immunotherapies in reducing mortality and adverse events, and improving quality of life in mRCC.