Division of Hematology Oncology, Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA.
Barts Health NHS Trust and the Royal Free NHS Foundation Trust, Barts Cancer Institute, and Queen Mary University of London, London, United Kingdom.
Am Soc Clin Oncol Educ Book. 2021 Jun;41:e182-e189. doi: 10.1200/EDBK_323835.
Immune checkpoint inhibitors have an established role in the treatment of newly diagnosed metastatic kidney cancer. Treatment regimens combining nivolumab plus ipilimumab, pembrolizumab plus axitinib, nivolumab plus cabozantinib, and pembrolizumab plus lenvatinib have demonstrated superior overall survival compared with sunitinib in randomized studies. Response rates vary from 42% to 71.1% with these combinations. Atezolizumab and pembrolizumab have been approved for the treatment of cisplatin-ineligible patients with metastatic bladder cancer. These and other checkpoint inhibitors have been studied in metastatic bladder cancer and are routinely used after progression on platinum-based chemotherapy. Durable responses are observed in bladder and kidney cancer. Although some patients may experience immune-related adverse events requiring treatment discontinuation, a portion of these patients will continue to experience a response off-therapy. At the time of progression, patients with metastatic kidney cancer may be treated with antiangiogenesis agents, and there are data suggesting that they may also be treated with a rechallenge of immunotherapy. In patients with metastatic bladder cancer who have progression after immune checkpoint inhibition, there are considerable data supporting the use of enfortumab vedotin. Ongoing studies are evaluating novel combinations of immune checkpoint inhibitors with other agents; thus, the treatment landscape of metastatic bladder and kidney cancer is expected to continue to evolve rapidly.
免疫检查点抑制剂在治疗新诊断的转移性肾细胞癌方面具有明确的作用。在随机研究中，与舒尼替尼相比，联合使用纳武单抗加伊匹单抗、帕博利珠单抗加阿昔替尼、纳武单抗加卡博替尼和帕博利珠单抗加仑伐替尼的治疗方案显示出了更好的总生存期。这些组合的缓解率从 42%到 71.1%不等。阿替利珠单抗和派姆单抗已被批准用于治疗转移性膀胱癌中不适合顺铂治疗的患者。这些药物和其他检查点抑制剂已在转移性膀胱癌中进行了研究，并在铂类化疗进展后常规使用。在膀胱癌和肾癌中观察到持久的缓解。尽管一些患者可能会出现需要停药的免疫相关不良反应，但其中一部分患者将继续在停药后产生反应。在转移性肾细胞癌进展时，患者可使用抗血管生成药物治疗，并且有数据表明，他们也可能用免疫治疗的再挑战来治疗。在接受免疫检查点抑制剂治疗后进展的转移性膀胱癌患者中，有大量数据支持使用恩福妥单抗。正在进行的研究评估了免疫检查点抑制剂与其他药物的新组合；因此，转移性膀胱癌和肾癌的治疗格局预计将继续快速发展。
