Chen Yu-Wei, Rini Brian I, Beckermann Kathryn E
Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA.
Cancers (Basel). 2022 Oct 4;14(19):4843. doi: 10.3390/cancers14194843.
The dual immune checkpoint blockade targeting CTLA-4 and PD-1 (ipilimumab/nivolumab) or the IO combinations targeting PD-1 and anti-VEGF TKIs (pembrolizumab/axitinib, nivolumab/cabozantinib, pembrolizumab/lenvatinib) have demonstrated an overall survival benefit in advanced clear cell renal cell carcinoma (ccRCC). Despite this significant improvement in clinical outcomes in the frontline setting from IO/IO or the IO/TKI combinations, there is a subset of patients of advanced ccRCC that do not respond to such combinations or will lose the initial efficacy and have disease progression. Therefore, a remarkable unmet need exists to develop new therapeutics to improve outcomes. With an enhanced understanding of ccRCC biology and its interaction with the tumor microenvironment, several new therapies are under development targeting ccRCC metabolism, cytokine-signaling, alternative immune checkpoint proteins, and novel biological pathways. In addition, microbiome products enhancing IO response, antibody-drug conjugates, and targeted radionuclides are also being investigated. This review summarizes selected emerging agents that are under development in ccRCC.
针对CTLA-4和PD-1的双重免疫检查点阻断疗法(伊匹单抗/纳武单抗)或针对PD-1和抗血管内皮生长因子酪氨酸激酶抑制剂的免疫肿瘤学联合疗法(帕博利珠单抗/阿昔替尼、纳武单抗/卡博替尼、帕博利珠单抗/乐伐替尼)已在晚期肾透明细胞癌(ccRCC)中显示出总生存获益。尽管免疫肿瘤学联合疗法(IO/IO)或免疫肿瘤学与酪氨酸激酶抑制剂联合疗法(IO/TKI)在一线治疗中显著改善了临床结局,但仍有一部分晚期ccRCC患者对此类联合疗法无反应或会失去初始疗效并出现疾病进展。因此,开发新的治疗方法以改善治疗效果存在明显的未满足需求。随着对ccRCC生物学及其与肿瘤微环境相互作用的深入了解,目前正在开发几种针对ccRCC代谢、细胞因子信号传导、替代性免疫检查点蛋白和新生物学途径的新疗法。此外,增强免疫肿瘤学反应的微生物组产物、抗体药物偶联物和靶向放射性核素也在研究中。本综述总结了ccRCC中正在开发的部分新兴药物。