The last three decades have witnessed a revolution in the therapeutic scenario of metastatic renal cell carcinoma (mRCC), due to the advent of novel agents including tyrosine kinase inhibitors, immune checkpoint inhibitors and the combination of both treatments. These strategies have reported unprecedented response rates, thus improving the clinical outcomes of mRCC patients, and current international guidelines support the use of immune-based combinations as first-line treatment in patients with metastatic disease. However, more data are awaited to help clinicians in the decision-making process. Herein, we provide an overview of recently published results regarding immune-based combinations as first-line treatment in mRCC patients, critically discussing available data that could help in suggesting determinants of treatment in this setting.
Keywords: cabozantinib; immune checkpoint inhibitors; immunotherapy; ipilimumab; nivolumab; renal cell carcinoma.
Lay abstract In the recent years, the treatment of metastatic renal cell carcinoma drastically changed with the introduction of immunotherapy, a type of therapy that stimulates the immune response against tumor cells. Combination treatments with two different immunotherapy agents or an immune checkpoint inhibitor and an anti-angiogenic agent (a drug that blocks vascularization of the tumor) are associated with prolonged responses and increased patients’ survival. We performed an overview of the recent studies of first-line treatment for metastatic renal cell carcinoma, critically analyzing important issues to consider when choosing a specific treatment.