The society for immunotherapy of cancer consensus statement on immunotherapy for the treatment of advanced renal cell carcinoma (RCC)

Abstract

The approval of immunotherapeutic agents and immunotherapy-based combination strategies in recent years has revolutionized the treatment of patients with advanced renal cell carcinoma (aRCC). Nivolumab, a programmed death 1 (PD-1) immune checkpoint inhibitor monoclonal antibody, was approved as monotherapy in 2015 for aRCC after treatment with a VEGF-targeting agent. In April 2018, the combination of nivolumab and ipilimumab, a CTLA-4 inhibitor, was approved for intermediate- and poor-risk, previously untreated patients with aRCC. Then, in 2019, combinations therapies consisting of pembrolizumab (anti-PD-1) or avelumab (anti-PD-ligand (L) 1) with axitinib (a VEGF receptor tyrosine kinase inhibitor) were also approved to treat aRCC and are likely to produce dramatic shifts in the therapeutic landscape. To address the rapid advances in immunotherapy options for patients with aRCC, the Society for Immunotherapy of Cancer (SITC) reconvened its Cancer Immunotherapy Guidelines (CIG) Renal Cell Carcinoma Subcommittee and tasked it with generating updated consensus recommendations for the treatment of patients with this disease.

Interdisziplinäre Empfehlungen zur Behandlung des fortgeschrittenen Nierenzellkarzinoms

“…Unter Therapien mit Checkpoint-Inhibitoren ist eine Remissionsbeurteilung nach 6 bis 12 Wochen oder später sinnvoll [25]. Des Weiteren gelten neben den RECIST-Kriterien 1.1 immune-related Response-Kriterien (irRC) und immune-related RECIST-Kriterien (irRECIST) [10].…”

“…In einer nicht randomisierten Phase-II-Studie war das OS der Patienten, die nach Progression mit Nivolumab weitertherapiert wurden, länger als das der Patienten mit Therapieabbruch bei Progression (30,5 vs. 15,2 Monate) [58,59]. Die SITC empfiehlt die Immuntherapie mit CPI in folgenden Fällen zu beenden [10]: ▪ bei Erreichen einer CR ▪ bei bestätigter symptomatischer Progression ▪ wenn die Therapie zwei Jahre gegeben wurde und kein Progress vorliegt…”

“…In der Regel kommen Kortikosteroide zum Einsatz. Bei höhergradiger Ausprägung muss die Behandung pausiert oder abgesetzt werden [10,60]. Treten trotz eines adäquaten Nebenwirkungsmanagements nicht ausreichend beherrschbare, intolerable Nebenwirkungen auf, ist ggf.…”

Profiling the inhibitory receptors LAG-3, TIM-3, and TIGIT in renal cell carcinoma reveals malignancy

“…The clinical success of the initial inhibitory receptors (IRs) CTLA-4, PD-1 or PD-L1 in cancers is still fresh in our minds (1)(2)(3)(4). With the substantial survival bene ts offered by nivolumab, which targets PD-1 (5,6), renal cell carcinoma (RCC) has become a hallmark of immune-oncology treatment in this decade.…”

“…The clinical e cacy achieved by the combination of ipilimumab, which targets CTLA-4, and nivolumab in RCC (7,8) has encouraged both patients and clinicians. However, a substantial proportion of patients remained refractory or developed acquired resistance to the rst series of immunotherapy regimens (i.e., CTLA-4, PD-1 or PD-L1 monotherapy and their combinations) (3,9). Thus, emerging demands for new therapies targeting other IRs have broadened the therapeutic repertoire in RCC and, more broadly, all cancer types.…”