Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC.
Loyola University-Stritch School of Medicine, Maywood, IL.
Ann Oncol. 2017 Jul 1;28(7):1484-1494. doi: 10.1093/annonc/mdx151.
In recent years, there has been dramatic expansion of the treatment armamentarium for patients with advanced renal cell carcinoma (aRCC), including drugs targeting vascular endothelial growth factor and mammalian target of rapamycin (mTOR) pathways. Despite these advances, patient outcomes remain suboptimal, underscoring the need for therapeutic interventions with novel mechanisms of action. The advent of immunotherapy with checkpoint inhibitors has led to significant changes in the treatment landscape for several solid malignancies. Specifically, drugs targeting the programmed death 1 (PD-1) and cytotoxic T-lymphocyte associated antigen (CTLA-4) pathways have demonstrated considerable clinical efficacy and gained regulatory approval as single-agent or combination therapy for the treatment of patients with metastatic melanoma, non-small cell lung cancer, aRCC, advanced squamous cell carcinoma of the head and neck, urothelial cancer and Hodgkin lymphoma. In aRCC, the PD-1 inhibitor nivolumab was approved in both the United States and Europe for the treatment of patients who have received prior therapy, based on improved overall survival compared with the mTOR inhibitor everolimus. Other checkpoint inhibitors, including the CTLA-4 inhibitor ipilimumab in combination with several agents, and the PD-L1 inhibitor atezolizumab, are in various stages of clinical development in patients with aRCC. In this review, current evidence related to the clinical use of checkpoint inhibitors for the treatment of patients with aRCC is discussed, including information on the frequency and management of unconventional responses and the management of immune-related adverse events. In addition, perspectives on the future use of checkpoint inhibitors are discussed, including the potential value of treatment beyond progression, the potential use in earlier lines of care or in combination with other agents, and the identification of biomarkers to guide patient selection and enable individualization of therapy.
近年来,晚期肾细胞癌(aRCC)患者的治疗手段有了显著扩展,包括针对血管内皮生长因子和哺乳动物雷帕霉素靶蛋白(mTOR)途径的药物。尽管取得了这些进展,但患者的结局仍不理想,这突显了需要采用具有新型作用机制的治疗干预措施。免疫检查点抑制剂的出现导致了几种实体恶性肿瘤治疗格局的重大变化。具体而言,针对程序性死亡 1(PD-1)和细胞毒性 T 淋巴细胞相关抗原(CTLA-4)途径的药物已显示出相当大的临床疗效,并获得监管部门批准,可作为单一药物或联合疗法,用于治疗转移性黑色素瘤、非小细胞肺癌、aRCC、晚期头颈部鳞状细胞癌、尿路上皮癌和霍奇金淋巴瘤患者。在 aRCC 中,基于总生存期优于 mTOR 抑制剂依维莫司,美国和欧洲均批准 PD-1 抑制剂纳武利尤单抗用于接受过治疗的患者。其他检查点抑制剂,包括 CTLA-4 抑制剂伊匹单抗与几种药物联合使用,以及 PD-L1 抑制剂阿替利珠单抗,也在 aRCC 患者中处于不同的临床开发阶段。本文讨论了检查点抑制剂治疗 aRCC 患者的临床应用相关的当前证据,包括关于非常规反应的频率和管理以及免疫相关不良事件管理的信息。此外,还讨论了检查点抑制剂的未来应用前景,包括治疗进展后潜在的价值、在早期治疗线或与其他药物联合使用的潜在用途,以及鉴定生物标志物以指导患者选择并实现个体化治疗。
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