[Risk-adapted therapy for metastatic renal cell carcinoma]

Area of Science:

• Oncology
• Immunotherapy
• Renal Cell Carcinoma Research

Background:

• Metastatic renal cell carcinoma (mRCC) treatment has evolved significantly.
• Sunitinib was the previous standard of care for first-line mRCC treatment.
• Pivotal phase 3 studies have reshaped the first-line treatment paradigm.

Purpose of the Study:

• To evaluate the efficacy and safety of novel first-line treatments for mRCC.
• To compare immune checkpoint inhibitor combinations against sunitinib.
• To assess survival outcomes, response rates, and quality of life.

Main Methods:

• Analysis of pivotal phase 3 clinical trial data.
• Comparison of immune checkpoint inhibitor combinations (nivolumab/ipilimumab, pembrolizumab/avelumab plus axitinib) with sunitinib.
• Evaluation of efficacy endpoints including overall survival, progression-free survival, and response rates.
• Assessment of safety profiles and quality of life.

Main Results:

• Immune checkpoint inhibitor combinations demonstrated superior efficacy compared to sunitinib.
• Nivolumab plus ipilimumab showed survival advantage, high complete response rates, and durable remission.
• Pembrolizumab or avelumab plus axitinib improved progression-free survival and response rates.
• While immune-mediated side effects occurred, some combinations offered better quality of life than sunitinib.

Conclusions:

• Immune checkpoint inhibitors (PD-1/PD-L1 inhibitors) are now the backbone of first-line therapy for mRCC.
• Combinations like nivolumab/ipilimumab and pembrolizumab/avelumab plus axitinib offer significant survival benefits.
• VEGFR-TKI monotherapy remains an option for specific patient groups or contraindications.