An update on safety evaluation of immune-based combinations in patients with advanced renal cell carcinoma
Matteo Rosellini1,2, Elisa Tassinari1,2, Andrea Marchetti1,2
1Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Introduction:
Significant advances have been made in the first-line therapy of metastatic renal cell carcinoma (mRCC) since the approval of immune-based combinations, including nivolumab plus ipilimumab or cabozantinib, and pembrolizumab plus axitinib or lenvatinib.
Areas Covered:
The aim of this review is to compare the different safety profiles of first-line immune-based combinations versus sunitinib across the four respective pivotal trials (CheckMate 214, CheckMate 9ER, KEYNOTE-426, and CLEAR), with a particular attention to patients' health-related quality of life (HRQoL) assessment.
Expert Opinion:
The concurrent use of an immune-checkpoint inhibitor (ICI) with a tyrosine kinase inhibitor (TKI) as a first-line treatment strategy for mRCC has highlighted the unmet clinical need for prompt detection and consequently proper management of adverse events (AEs), both immune-related and TKI-induced. Overlapping AEs, such as hypertransaminasemia, are most challenging to manage, and evidence is still outlined from clinical practice. The specific patterns of toxicities of the approved first-line immune-based combinations, along with the impact of these interventions on patients' HRQoL, demand a deeper consideration by physicians while choosing the appropriate treatment for each individual mRCC patient. Both safety profile and HRQoL evaluation could be exploited to guide the first-line treatment selection in this setting.
Insights
New first-line treatments for metastatic renal cell carcinoma (mRCC) offer improved outcomes. This review compares safety profiles and quality of life impacts of immune-based combinations versus sunitinib in mRCC patients.
Area of Science:
- Oncology
- Immunotherapy
- Pharmacology
Background:
- Metastatic renal cell carcinoma (mRCC) treatment has advanced with immune-based combinations.
- First-line options now include nivolumab plus ipilimumab or cabozantinib, and pembrolizumab plus axitinib or lenvatinib.
Approach:
- This review compares safety profiles of first-line immune-based combinations against sunitinib.
- It analyzes data from pivotal trials: CheckMate 214, CheckMate 9ER, KEYNOTE-426, and CLEAR.
- Patient health-related quality of life (HRQoL) is a key focus.
Key Points:
- Concurrent use of immune-checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) requires careful management of overlapping adverse events (AEs).
- Immune-related and TKI-induced AEs, like hypertransaminasemia, present management challenges.
- Understanding specific toxicity patterns and HRQoL impact is crucial for treatment selection.
Conclusions:
- Physicians must consider both safety and HRQoL when selecting first-line therapy for mRCC.
- Safety profiles and HRQoL assessments can guide optimal treatment choices in mRCC.
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