Patient selection and risk factors in the changing treatment landscape of metastatic renal cell carcinoma

Abstract

Introduction: The approval of combination treatments for metastatic renal cell carcinoma (mRCC) represents a major change in the clinical management of this malignancy. Updated treatment guidelines differentiate first-line mRCC treatment by patient risk group as defined by prognostic models and the number of risk factors. Areas covered: Current prognostic models, with a focus on the International Metastatic RCC Database Consortium and the Memorial Sloan Kettering Cancer Center models, the heterogeneity of the intermediate risk group, and first-and second-line mRCC treatment outcomes according to patient risk group are discussed. Consideration is given to the future direction of treatment selection strategies including refinement of prognostic factors, genetic biomarkers and gene signatures. Expert opinion: Current prognostic models require updating, but initial data suggests they are effective in stratifying patients treated with immune checkpoint inhibitors or combination therapy. Treatment selection for patients with 1-2 risk factors may require further consideration due to the heterogeneous nature of the intermediate risk group. Future prognostic models may benefit from inclusion of gene signatures and stratification by molecular subtype. Prognostic risk factors are not the only consideration in treatment selection; tumor burden, location of metastases, and comorbidities, among other factors, should also be considered.

RCC Real-World Data: Prognostic Factors and Risk Stratification in the Immunotherapy Era

“…The variety of available life-prolonging CPI-based treatment combinations has made treatment decisions challenging, as these combinations have not been compared to each other. The treatment is chosen to take into account the patient's clinical condition [29] and the risk group as defined by Heng's criteria developed in 2009 in a completely different clinical scenario when the main treatment options were VEGFRi.…”

“…We included clinical, pathological, and laboratory values. Future prognostic models for CPI combination therapies may be enhanced by the inclusion of genetic markers or gene signatures, but these are currently clinically unavailable [29].…”

Cancer research in the United Arab Emirates from birth to present: A bibliometric analysis

“…On the other hand, due to numerous linguistic, cultural, and geographical similarities, there is cooperation between UCR scholars and Arab nations such as Egypt and, more recently, Jordan. Dawood, S., affiliated with the Department of Medical Oncology, Dubai Hospital, Dubai, U.A.E., created strong networks with Kuwait [ 44 ], Oman [ 45 ], Egypt, Saudi Arabia [ 46 ], the UK [ 47 ], and the USA [ 48 ]. The current study's pattern of international collaboration aligns with previous bibliometric studies conducted on cancer in the Arab world, as indicated by Refs.…”

“…Apoptosis, cell cycle, cisplatin, MCF-7, p53, anticancer, colon cancer, hepatocellular carcinoma, and DNA damage, and lung cancer are the backbone terms of the green cluster. The research focus of this knowledge domain spotted light on the discovery of new anticancer agents and utilization of in vitro cancer models [ [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] ]. Researchers in UAE have investigated the apoptotic effects of various compounds on cancer cells.…”