转移性肾细胞癌免疫治疗的合理治疗持续时间。

Rational Approaches to Treatment Duration with Immunotherapy in Metastatic Renal Cell Carcinoma.

机构信息

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

出版信息

Eur Urol Focus. 2020 Jan 15;6(1):31-33. doi: 10.1016/j.euf.2019.10.010. Epub 2019 Nov 19.

DOI:10.1016/j.euf.2019.10.010

PMID:31757714

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment paradigm for metastatic renal cell carcinoma. The appropriate duration for ICI treatment is not clear, however. Analyses of landmark trials reveal that some patients exhibit sustained durable responses to ICIs even after treatment discontinuation, resulting in prolonged treatment-free intervals that can mitigate potential toxicities and the considerable financial burden associated with treatment. Adaptive approaches with PD1 monotherapy and combination immunotherapy tailored to tumor response are ongoing. More efforts will be needed to clarify the ideal ICI dosing regimen to maximize oncological benefit while minimizing treatment-related adverse effects and costs. PATIENT SUMMARY: We reviewed considerations surrounding treatment strategies when using immunotherapy to treat patients with kidney cancer. It is clear that some patients can experience prolonged cancer control when discontinuing immunotherapy. However, individualized approaches will be necessary to strike a balance between optimizing patient outcomes and reducing unnecessary side effects and cost.

摘要

免疫检查点抑制剂 (ICIs) 彻底改变了转移性肾细胞癌的治疗模式。然而，ICI 治疗的适当持续时间尚不清楚。对标志性试验的分析表明，即使在停止治疗后，一些患者对 ICI 仍表现出持续的持久反应，从而延长了无治疗间隔，这可以减轻潜在的毒性和与治疗相关的巨大经济负担。正在进行针对肿瘤反应的 PD1 单药和联合免疫治疗的适应性方法。需要进一步努力来阐明理想的 ICI 剂量方案，以最大限度地提高肿瘤学益处，同时最大限度地减少与治疗相关的不良反应和成本。患者总结：我们回顾了使用免疫疗法治疗肾癌患者时的治疗策略考虑因素。很明显，当停止免疫治疗时，一些患者可以获得更长时间的癌症控制。然而，需要采取个体化的方法，在优化患者结局和减少不必要的副作用和成本之间取得平衡。