Medicine and Surgery Department, University of Parma, Parma, Italy.
Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
Expert Rev Anticancer Ther. 2021 Apr;21(4):401-412. doi: 10.1080/14737140.2021.1861941. Epub 2020 Dec 23.
: In recent years, the systemic treatment of patients with metastatic renal-cell carcinoma (mRCC) has undergone profound innovations, offering the availability of new drugs, and raising the bar of the survival expectation in this, previously, almost-always, incurable disease. The likeliness of reaching durable response and long-term survival is still closely linked to good clinical management and smart treatment sequencing, rather than to a single systemic treatment choice.: We review all systemic therapeutic options currently available, describe the evidence behind the current options available for mRCC patient treatment, and provide our personal cues to support clinical decisions.: The IMDC classification is still the only widely validated tool for the choice of primary therapy. Other elements should then be considered for selecting patients who can still receive TKI monotherapy (good-risk patients) or who deserve an 'all-at-once' approach with TKI plus ICI (poor-risk patients with the high metastatic burden and poor-prognosis organ involvement, likely not able to achieve a second chance), identifying these two 'extreme' situations and setting all the other treatment choices on the basis of several nuances. In the second- and further-line settings, ad-hoc prospective trials are awaited.
近年来，转移性肾细胞癌（mRCC）患者的系统治疗发生了深刻的创新，提供了新的药物选择，并提高了这一以前几乎无法治愈的疾病的生存预期。持久反应和长期生存的可能性仍然与良好的临床管理和明智的治疗顺序密切相关，而不仅仅取决于单一的系统治疗选择。我们回顾了目前所有可用的系统治疗选择，描述了目前 mRCC 患者治疗可用选择的证据，并提供了我们的个人线索来支持临床决策。IMDC 分类仍然是选择主要治疗方法的唯一广泛验证工具。然后，应考虑其他因素来选择仍可接受 TKI 单药治疗的患者（低危患者）或需要 TKI 联合 ICI 的“全面”治疗的患者（高危患者，转移负担重，预后差的器官受累，可能无法获得第二次机会），确定这两种“极端”情况，并根据几个细微差别确定所有其他治疗选择。在二线及以上治疗环境中，需要进行专门的前瞻性试验。
