Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan.
PHCC at St. Clare's and St. Mary's General Hospital, Denville, NJ, USA.
Hematol Oncol Stem Cell Ther. 2023 Apr 4;16(3):170-185. doi: 10.56875/2589-0646.1027.
Renal cell carcinoma (RCC) is the most common kidney cancer in adults (approximately 90%), and clear cell RCC (ccRCC) is the most frequent histologic subtype (approximately 75%). We reviewed the safety and efficacy of checkpoint inhibitors (CPIs) in ccRCC, identifying 5927 articles in PubMed, Embase, Cochrane, and Web of Science. Ten randomized control (N = 7765) and 10 non-randomized (N = 572) studies were included. Overall, 4819 patients treated with CPI combinations were compared with everolimus, sunitinib, or placebo. Overall response rates (ORR) were 9-25% with nivolumab (niv), 42% with niv + ipilimumab (ipi), 55.7% with niv + cabozantinib, 56% with niv + tivozanib vs. 5% with everolimus. ORR was 51.5-58% with avelumab + axitinib vs. 25.5% with sunitinib. ORR was 59.3-73% with pembrolizumab + tyrosine kinase inhibitor vs. 25.7% with sunitinib. ORR was 32-36% with atezolizumab + bevacizumab vs. 29-33% with sunitinib. In patients with PD-L1+ve and -ve ccRCC, niv, atezolizumab, ipi, and pembrolizumab were safe and effective alone and when combined with cabozantinib, tivozanib, axitinib, levantinib, and pegilodecakin. Atezolizumab + bevacizumab was safe and effective in ccRCC with high PD-L1 expression. Pembrolizumab was safe and effective in preventing recurrence in ccRCC patients with nephrectomy. Additional randomized, double-blind, multicenter clinical trials are needed to confirm these results.
肾细胞癌 (RCC) 是成人中最常见的肾癌 (约 90%)，透明细胞 RCC (ccRCC) 是最常见的组织学亚型 (约 75%)。我们回顾了检查点抑制剂 (CPIs) 在 ccRCC 中的安全性和疗效，在 PubMed、Embase、Cochrane 和 Web of Science 中检索到 5927 篇文章。纳入了 10 项随机对照 (N = 7765) 和 10 项非随机对照 (N = 572) 研究。总体而言，4819 例接受 CPI 联合治疗的患者与依维莫司、舒尼替尼或安慰剂进行了比较。纳武单抗 (niv) 的总体缓解率 (ORR) 为 9-25%，niv + ipilimumab (ipi) 为 42%，niv + cabozantinib 为 55.7%，niv + tivozanib 为 56%，依维莫司为 5%。avelumab + axitinib 的 ORR 为 51.5-58%，舒尼替尼为 25.5%。pembrolizumab + 酪氨酸激酶抑制剂的 ORR 为 59.3-73%，舒尼替尼为 25.7%。atezolizumab + bevacizumab 的 ORR 为 32-36%，舒尼替尼为 29-33%。在 PD-L1+ve 和 -ve ccRCC 患者中，niv、atezolizumab、ipi 和 pembrolizumab 单独使用以及与 cabozantinib、tivozanib、axitinib、levantinib 和 pegilodecakin 联合使用是安全有效的。在 PD-L1 高表达的 ccRCC 中，atezolizumab + bevacizumab 是安全有效的。pembrolizumab 可安全有效地预防肾细胞癌患者肾切除术后的复发。需要进一步的随机、双盲、多中心临床试验来证实这些结果。
