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First-Line Systemic Treatment Options for Advanced Renal Cell Carcinoma

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Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma

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Abstract

The treatment of advanced clear cell renal cell carcinoma (ccRCC) has undergone significant changes over the last two decades, particularly with the development of antiangiogenic therapies, in particular vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). The first-line therapeutic paradigm is dominated by combination therapies of ICI/ICI or TKI/ICI, although high-dose interleukin (IL)-2 or individual TKIs are still used in limited circumstances. This chapter provides a historical overview with a focus on currently FDA approved ICI combinations: ipilimumab/nivolumab, axitinib/pembrolizumab, axitinib/avelumab, cabozantinib/nivolumab, and lenvatinib/pembrolizumab. Challenges and approaches to therapeutic choices are also explored.

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Abbreviations

axi-ave:

Axitinib/avelumab

axi-pembro:

Axitinib/pembrolizumab

cabo-nivo:

Cabozantinib/nivolumab

ccRCC:

Clear cell renal cell carcinoma

c-Kit:

Stem cell factor receptor

CI:

Confidence interval

CR:

Complete response

CSF-1R:

Colony-stimulating factor-1 receptor

CTLA-3:

Cytotoxic T-lymphocyte-associated protein

FDA:

Food and Drug Administration

FLT3:

FMS-like tyrosine kinase 3

HR:

Hazard ratio

ICI:

Immune checkpoint inhibitor

IFN:

Interferon

IL-2:

Interleukin-2

IMDC:

International Metastatic RCC Database Consortium

ipi-nivo:

Ipilimumab/nivolumab

IRAE:

Immune-related adverse events

ITT:

Intention to treat

IV:

Intravenous

len-pembro:

Lenvatinib/pembrolizumab

MSKCC:

Memorial Sloan-Kettering Cancer Center

MU:

Million international units

NCCN:

National Comprehensive Cancer Network

ORR:

Overall response rate

OS:

Overall survival

PDGFR:

Platelet-derived growth factor receptor

PD-1:

Programmed cell death-1

PD-L1:

Programmed death-ligand 1

PFS:

Progression free survival

PR:

Partial response

QoL:

Quality of life

RCC:

Renal cell carcinoma

RET:

Ret Proto-Oncogene

RF:

Risk factor

TFS:

Treatment-free survival

TKI:

Tyrosine kinase inhibitor

TRAE:

Treatment-related adverse event

US:

United states

v.:

Versus

VEGF:

Vascular endothelial growth factor

VEGFR:

Vascular endothelial growth factor receptor

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Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA

    Qian Qin, James Brugarolas, Hans Hammers & Tian Zhang

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  1. Qian Qin
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  2. James Brugarolas
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  3. Hans Hammers
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  4. Tian Zhang
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Correspondence to Tian Zhang .

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Editors and Affiliations

  1. Moores Cancer Center, University of California San Diego, La Jolla, CA, USA

    Rana R. McKay

  2. Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Eric A. Singer

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Qin, Q., Brugarolas, J., Hammers, H., Zhang, T. (2023). First-Line Systemic Treatment Options for Advanced Renal Cell Carcinoma. In: McKay, R.R., Singer, E.A. (eds) Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma. Springer, Cham. https://doi.org/10.1007/978-3-031-40901-1_12

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  • DOI: https://doi.org/10.1007/978-3-031-40901-1_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-40900-4

  • Online ISBN: 978-3-031-40901-1

  • eBook Packages: MedicineMedicine (R0)

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