Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma

Rini, Brian I.; Plimack, Elizabeth R.; Stus, V.P.; Gafanov, Rustem; Hawkins, Robert E.; Nosov, Dmitry; Pouliot, Frédéric; Alekseev, B. Ya.; Soulières, Denis; Melichar, Bohuslav; Vynnychenko, Ihor; Kryzhanivska, Anna; Bondarenko, Igor; Azevedo, Sérgio Jobim; Borchiellini, Delphine; Szczylik, Cezary; Markus, M.; McDermott, Ray; Bedke, Jens; Tartas, Sophie; Chang, Yen‐Hwa; Tamada, Satoshi; Shou, Qiong; Perini, Rodolfo F.; Chen, Mei; Atkins, Michael B.; Powles, Thomas

doi:10.1056/nejmoa1816714

Cited by 2,617 publications

(2,317 citation statements)

References 16 publications

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“…The main purpose of the four‐tier model was the separation of prognosis in patients in the IMDC intermediate‐risk group in the immunotherapy era. Within a year, we need to select “avelumab/pembrolizumab + axitinib” or “nivolumab + ipilimumab” for the patients in the intermediate/poor risk groups . Currently, the recommendation of optimal treatment selection in those patients is not available.…”

Section: Discussionmentioning

confidence: 99%

C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

et al. 2019

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Objectives To evaluate the effect of pretreatment C‐reactive protein/albumin ratio and modified Glasgow prognostic score on the prognosis in patients with metastatic renal cell carcinoma. Methods A retrospective study was carried out in 176 patients with metastatic renal cell carcinoma who received first‐line tyrosine kinase inhibitors. The effect of adding inflammatory prognostic scores to the International Metastatic Renal Cell Carcinoma Database Consortium model (International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio and International Metastatic Renal Cell Carcinoma Database Consortium‐Glasgow prognostic score models) on overall survival was evaluated using receiver operating characteristic curves. The prognostic value of inflammatory prognostic scores (C‐reactive protein/albumin ratio‐modified Glasgow prognostic score) was tested using the Kaplan–Meier method and Cox proportional regression models. Results Patients were stratified into two groups using the cut‐off value of 0.05: C‐reactive protein/albumin ratio‐low (<0.05) and C‐reactive protein/albumin ratio‐high (≥0.05). The area under the curve was significantly higher in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model (0.720) than that of the International Metastatic Renal Cell Carcinoma Database Consortium model (0.689) and the International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score model (0.703). Significant differences were observed in overall survival stratified by the number of risk factors in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio risk model between one or two and three or four factors (P < 0.001), and three or four and five or more factors (P = 0.001). For the patients in the International Metastatic Renal Cell Carcinoma Database Consortium intermediate‐risk group, overall survival was significantly different between the C‐reactive protein/albumin ratio‐low and ‐high groups (P = 0.001), whereas it was not significantly different between the patients with one and two International Metastatic Renal Cell Carcinoma Database Consortium risk factors (P = 0.106). Conclusion The C‐reactive protein/albumin ratio is a simple and independent predictor of overall survival in patients with metastatic renal cell carcinoma. The predictive activity was significantly improved in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model compared with the International Metastatic Renal Cell Carcinoma Database Consortium/International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score models.

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Section: Discussionmentioning

confidence: 99%

C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

et al. 2019

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“…Favorable outcomes have been observed with sunitinib, pazopanib, bevacizumab, and most recently axitinib in combination with PD‐1/PD‐L1 inhibitors . In the KEYNOTE‐426 study for renal cell carcinoma, sunitinib was compared to pembrolizumab plus axitinib and resulted in improved OS, median PFS, and objective response rate, which was independent of PD‐L1 expression …”

Section: Sarcomas—a Framework For Approaching Modern Immunotherapymentioning

confidence: 99%

Immune checkpoint inhibitors: The linchpins of modern immunotherapy

Wilky

2019

Immunological Reviews

167

113

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Immune checkpoint inhibitors (ICIs) have revolutionized our approach to cancer treatment in the past decade. While monoclonal antibodies to CTLA‐4 and PD‐1/PD‐L1 have produced remarkable and durable responses in a subset of patients, the majority of patients will still develop primary or adaptive resistance. With complex mechanisms of resistance limiting the efficacy of checkpoint inhibitor monotherapy, it is critical to develop combination approaches to allow more patients to benefit from immunotherapy. In this review, I approach the current landscape of ICI research from the perspective of sarcomas, a rare group of bone and soft tissue cancers that have had limited benefit from checkpoint inhibitor monotherapy, and little investigation of biomarkers to predict responses. By surveying the various mechanisms of resistance and treatment modalities being explored in other solid tumors, I outline how ICIs will undoubtedly serve as the critical foundation for future directions in modern immunotherapy.

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“…Approval was based on the Keystone‐426 trial, a randomized, multicentric trial. The trial demonstrated a statistically significant improvement in overall survival in patients treated with the above combination versus those treated with sunitinib . Pembrolizumab has also been used in metastatic cervical, endometrial, squamous cell lung cancer, and melanomas .…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab‐axitinib‐induced tumor lysis syndrome in a patient with metastatic renal cancer

Shah

Jain

Abe

et al. 2020

Clinical Case Reports

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Tumor lysis syndrome is uncommon in solid tumors but with the use of immunotherapy (checkpoint inhibitors) their incidence is increasing. Physicians need to take adequate precautions while treating patients with immunotherapy. The findings of our case report will help improve our current understanding of tumor lysis syndrome specially in solid tumors and will help in developing multidisciplinary treatment and prophylaxis strategies for this uncommon, but potentially fatal complication.

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Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma

Cited by 2,617 publications

References 16 publications

C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

Immune checkpoint inhibitors: The linchpins of modern immunotherapy

Pembrolizumab‐axitinib‐induced tumor lysis syndrome in a patient with metastatic renal cancer

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