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Current State of Systemic Therapies for Advanced Renal Cell Carcinoma

Abstract

Purpose of Review

Due to the rapidly changing field of kidney cancer therapeutics, addressing the state of the art systemic therapy regimens, and sequencing with cytoreductive nephrectomy are the primary focus of this review. We will also discuss the role of biomarkers and novel therapeutic targets in the management of renal cell carcinoma.

Recent Findings

The management of metastatic renal cell cancer has undergone a paradigm shift with immune checkpoint inhibitors being used in the frontline setting. Over the last 4 years, programmed cell death-1 (PD-1) inhibitors as well as programmed cell death ligand-1 inhibitors have become available in various combinations with cytotoxic T lymphocyte-associated protein-4 (CTLA-4) inhibitors and tyrosine kinase inhibitors (TKIs). These drugs have improved outcomes in patients with renal cell cancer and more work is being done to refine these targets as well as discover newer ones.

Summary

Despite the availability of several new treatment options, some questions that still need to be addressed in the management of kidney cancer include the sequencing of treatment options, treatment of patients who progress on immune checkpoint inhibitors, and role of biomarkers to ascertain the best treatment options to minimize costs and improve outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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    • Flippot R, et al. Atezolizumab plus bevacizumab in non-clear cell renal cell carcinoma (NccRCC) and clear cell renal cell carcinoma with sarcomatoid differentiation (ccRCCsd): updated results of activity and predictive biomarkers from a phase II study. JCO. 2019;37:4583–3. Papers 57–-60 are important trials addressing the role of immunotherapy drugs in non-clear cell RCC.

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Correspondence to Ulka Vaishampayan.

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Shuchi Gulati declares that she has no conflict of interest.

Ulka Vaishampayan has received research funding from Bristol-Myers Squibb and Exelixis, and has received compensation from Bristol-Myers Squibb, Exelixis, and Pfizer for service as a consultant.

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Gulati, S., Vaishampayan, U. Current State of Systemic Therapies for Advanced Renal Cell Carcinoma. Curr Oncol Rep 22, 26 (2020). https://doi.org/10.1007/s11912-020-0892-1

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Keywords

  • Kidney cancer
  • Clear cell
  • Non-clear cell
  • Treatment
  • Nephrectomy