Bedke Jens, Stühler Viktoria, Stenzl Arnulf, Brehmer Bernhard
Department of Urology, Eberhard Karls University, Tübingen, Germany.
Department of Urology, Diakonie Hospital, Schwäbisch Hall, Germany.
Curr Opin Urol. 2018 Jan;28(1):8-14. doi: 10.1097/MOU.0000000000000466.
The treatment landscape in advanced and metastatic renal cell carcinoma (RCC) is moving from the inhibition of tyrosine kinases (TKI) and the mammalian target of rapamycin (mTOR) inhibitors to specific immunooncology agents like immune checkpoint inhibitors (ICI). The review focus on the recent immunooncology developments and available trial results within the last 12 months.
ICI as monotherapy (nivolumab) or immunooncology and immunooncology combinations (nivolumab and ipilimumab) demonstrated positive results on prolonged overall survival in phase III trials. The combination of ICI (atezolizumab) and bevacizumab provided positive signals in prolonged PFS in the PD-L1 positive subgroup. Combinations of ICI and TKI are promising in early phase I and phase II trials. Results are currently expanded in larger phase III studies. The combination of vaccine and TKI in mRCC has not provided beneficial results so far.
The current treatment landscape in mRCC is shifting towards immunooncology agents, which already gained ground in the clinic as ICI monotherapy (nivolumab) or is likely to do in the near future as ICI combination (nivolumab and ipilimumab). The future will hold promise of new combinations with TKIs and ICI or other immunooncology agents like vaccines and metabolic immune checkpoint inhibitors.
晚期和转移性肾细胞癌（RCC）的治疗格局正从抑制酪氨酸激酶（TKI）和哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂转向免疫肿瘤学特异性药物，如免疫检查点抑制剂（ICI）。本综述聚焦于过去12个月内免疫肿瘤学的最新进展及现有试验结果。
ICI作为单药治疗（纳武单抗）或免疫肿瘤学联合治疗（纳武单抗和伊匹单抗）在III期试验中显示出延长总生存期的阳性结果。ICI（阿特珠单抗）和贝伐单抗的联合治疗在PD-L1阳性亚组中延长无进展生存期方面提供了阳性信号。ICI与TKI的联合在I期和II期早期试验中前景良好。目前结果正在更大规模的III期研究中扩展。疫苗与TKI联合用于转移性肾细胞癌（mRCC）目前尚未取得有益结果。
mRCC目前的治疗格局正转向免疫肿瘤学药物，ICI单药治疗（纳武单抗）已在临床中取得进展，或在不久的将来ICI联合治疗（纳武单抗和伊匹单抗）也可能取得进展。未来将有望出现TKI与ICI或其他免疫肿瘤学药物（如疫苗和代谢性免疫检查点抑制剂）的新联合治疗方案。
