Roberto Michela, Panebianco Martina, Aschelter Anna Maria, Buccilli Dorelsa, Cantisani Carmen, Caponnetto Salvatore, Cortesi Enrico, d'Amuri Sara, Fofi Claudia, Ierinò Debora, Maestrini Viviana, Marchetti Paolo, Marignani Massimo, Stigliano Antonio, Vivona Luca, Santini Daniele, Tomao Silverio
Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology Unit A, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
Department of Clinical and Molecular Medicine, Oncology Unit, Sant' Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Front Oncol. 2023 Jan 12;12:1026978. doi: 10.3389/fonc.2022.1026978. eCollection 2022.
The new landscape of treatments for metastatic clear cell renal carcinoma (mRCC) is constantly expanding, but it is associated with the emergence of novel toxicities, adding to up to those observed in the tyrosine-kinase inhibitor (TKI) era. Indeed, the introduction of immune checkpoint inhibitors (ICIs) alone or in combination has been associated with the development of immune-related adverse events (irAEs) involving multiple-organ systems which, even if rarely, had led to fatal outcomes. Moreover, due to the relatively recent addition of ICIs to the previously available treatments, the potential additive adverse effects of these combinations are still unknown. A prompt recognition and management of these toxicities currently represents a fundamental issue in oncology, since it correlates with the outcome of cancer patients. Even if clinical guidelines provide indications for the management of irAEs, no specific protocol to evaluate the individual risk of developing an adverse event during therapy is currently available. A multidisciplinary approach addressing appropriate interventions aimed at reducing the risk of any insidious, severe, and/or dose-limiting toxicity might represent the most efficacious strategy to timely prevent and manage severe irAEs, allowing indirectly to improve both patients' cancer-specific survival and quality of life. In this review, we reported a five-case series of toxicity events that occurred at our center during treatment for mRCC followed by the remarks of physicians from different specialties, pinpointing the relevant role of an integrated and extended multidisciplinary team in a modern model of mRCC patient management.
转移性透明细胞肾细胞癌（mRCC）的治疗新格局在不断扩展，但这与新毒性的出现相关，这些新毒性叠加了酪氨酸激酶抑制剂（TKI）时代所观察到的毒性。事实上，单独或联合使用免疫检查点抑制剂（ICI）已与涉及多器官系统的免疫相关不良事件（irAE）的发生相关，这些不良事件即使很少见，也已导致致命后果。此外，由于ICI是在先前可用治疗方法的基础上相对较新添加的，这些联合治疗的潜在附加不良反应仍然未知。目前，迅速识别和管理这些毒性是肿瘤学中的一个基本问题，因为它与癌症患者的预后相关。尽管临床指南为irAE的管理提供了指导，但目前尚无评估治疗期间发生不良事件个体风险的具体方案。一种多学科方法，采取适当干预措施以降低任何潜在的、严重的和/或剂量限制性毒性的风险，可能是及时预防和管理严重irAE的最有效策略，从而间接改善患者的癌症特异性生存率和生活质量。在本综述中，我们报告了在我们中心mRCC治疗期间发生的一系列五例毒性事件，随后不同专科的医生发表了评论，指出了一个综合和扩展的多学科团队在mRCC患者管理现代模式中的相关作用。
