Bersanelli Melissa, Buti Sebastiano
University Hospital of Parma, Medical Oncology Unit, Via Gramsci 14, 43126, Parma (PR), Italy.
University Hospital of Parma, Medical Oncology Unit, Parma (PR), Italy.
Ther Adv Med Oncol. 2017 Oct;9(10):627-636. doi: 10.1177/1758834017724314. Epub 2017 Aug 2.
Since the advent of immunotherapy revolutionized the treatment of metastatic renal cell carcinoma (mRCC), the attention of oncologists has been unavoidably shifted from tyrosine kinase inhibitors (TKIs) to immune checkpoint blockade, with the associated risk of listing cabozantinib as just one of many available TKIs. On the contrary, we think that cabozantinib represents a very good option for mRCC treatment, with outstanding outcomes in terms of response rate, progression-free survival, overall survival and quick time to treatment response. Its safety profile is acceptable and its discontinuation rate, due to toxicity, is similar to those of other TKIs. It is still not clear if the effectiveness of this drug is justified by its wide spectrum of multikinase activity, extended to the MET and AXL kinases, or by the simple maintenance of a 'vascular endothelial growth factor receptor pressure' after another previous TKI. Early-phase studies are currently ongoing to investigate the potential activity and safety of cabozantinib in association with immunotherapy, albeit with the risk of an overly toxic combination. Thus, future opportunities to improve the clinical use of this drug will probably be represented by a smart treatment sequence.
自从免疫疗法问世彻底改变了转移性肾细胞癌（mRCC）的治疗方式以来，肿瘤学家的注意力不可避免地从酪氨酸激酶抑制剂（TKIs）转向了免疫检查点阻断，这使得卡博替尼被列为众多可用TKIs之一，存在相应风险。相反，我们认为卡博替尼是mRCC治疗的一个非常好的选择，在缓解率、无进展生存期、总生存期和治疗反应时间方面都有出色的结果。其安全性是可接受的，因毒性导致的停药率与其他TKIs相似。目前尚不清楚该药物的有效性是因其广泛的多激酶活性（扩展至MET和AXL激酶），还是仅仅因为在先前使用另一种TKI后维持了“血管内皮生长因子受体压力”。目前正在进行早期研究，以调查卡博替尼与免疫疗法联合使用的潜在活性和安全性，尽管存在联合用药毒性过大的风险。因此，未来改善该药物临床应用的机会可能在于合理的治疗顺序。
