Shaw Tiffany, Lee Hannah, Figlin Robert
Cedars-Sinai Medical Center, Los Angeles, CA.
Cedars-Sinai Oschin Comprehensive Cancer Institute, Los Angeles, CA.
Oncology (Williston Park). 2021 Jun 16;35(6):306-310. doi: 10.46883/ONC.2021.3506.0306.
In recent years, first-line therapies for metastatic renal cell carcinoma (mRCC) have shifted to a combination of immune checkpoint inhibitors or a combination of antiangiogenesis tyrosine kinase inhibitors (TKIs) and immunotherapy. This has led to a need to address standard-of-care treatment in the second-line setting. Our review presents an analysis of current and upcoming data to guide treatment decisions. After progression on nivolumab plus ipilimumab, current data favor monotherapy TKI with cabozantinib or axitinib. Current literature for second-line therapy given after combination TKI plus immunotherapy shows the strongest evidence for either single-agent cabozantinib or combination everolimus with lenvatinib. Investigations are ongoing for the role of TKIs with immunotherapy in the second-line setting. Novel agents, such as HIF2α inhibitors, are currently being studied as single agents and in combination with other treatment modalities in efforts to improve patient outcomes in mRCC.
近年来，转移性肾细胞癌（mRCC）的一线治疗已转向免疫检查点抑制剂联合治疗或抗血管生成酪氨酸激酶抑制剂（TKIs）与免疫疗法联合治疗。这就需要解决二线治疗中的标准治疗问题。我们的综述对当前和即将出现的数据进行了分析，以指导治疗决策。在纳武单抗加伊匹单抗治疗进展后，目前的数据支持使用卡博替尼或阿昔替尼进行单药TKI治疗。目前关于TKI联合免疫疗法后二线治疗的文献表明，单药卡博替尼或依维莫司与乐伐替尼联合治疗的证据最为充分。目前正在研究TKIs与免疫疗法在二线治疗中的作用。新型药物，如HIF2α抑制剂，目前正在作为单药进行研究，并与其他治疗方式联合使用，以努力改善mRCC患者的预后。
