Medical Oncology Unit, Università Cattolica Del Sacro Cuore, Rome, Italy.
Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
Expert Rev Anticancer Ther. 2023 Jul;23(7):669-672. doi: 10.1080/14737140.2023.2218091. Epub 2023 May 29.
This article describes the main acquisitions of renal cell carcinoma (RCC) management presented during the 2023 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium. In particular, the efficacy of adjuvant pembrolizumab in patients with resected renal cell carcinoma (RCC) at increased risk of recurrence was confirmed through a subgroup analysis. In the metastatic setting, the updated analysis of the CheckMate 9ER study confirmed the efficacy in terms of overall survival (OS) of the combination of nivolumab plus cabozantinib; of note, this survival advantage was clear in the subgroup of patients at poor IMDC prognosis, but not in favorable IMDC risk group patients. As concern the triplet therapy (i.e. nivolumab+ipilumumab+cabozantinib), the updated analysis of the COSMIC-313 study confirmed a significant PFS advantage in the subgroup of mRCC patients at intermediate IMDC risk, while the lack of benefit in the poor risk group supports the critical role of immunotherapy (but not of VEGFR-TKIs) in this poor prognosis subgroup of patients. Finally, the activity of cabozantinib as second-line therapy after progression to ICI-based combinations was prospectively assessed. This 2023 ASCO Genitourinary Cancer Symposium laid the foundations for further knowledge development necessary for an increasingly personalized management of mRCC.
本文描述了在 2023 年美国临床肿瘤学会（ASCO）泌尿生殖系统癌症研讨会上展示的肾细胞癌（RCC）管理的主要进展。特别是，通过亚组分析证实了辅助 pembrolizumab 在复发风险增加的 RCC 患者中的疗效。在转移性环境中，CheckMate 9ER 研究的更新分析证实了 nivolumab 联合 cabozantinib 在总生存期（OS）方面的疗效；值得注意的是，这种生存优势在预后不良的 IMDC 亚组患者中明显，但在预后良好的 IMDC 风险组患者中并不明显。关于三联疗法（即 nivolumab+ipilimumab+cabozantinib），COSMIC-313 研究的更新分析证实了 mRCC 患者中 IMDC 风险中等亚组的 PFS 优势，而在风险较低的亚组中缺乏获益支持了免疫疗法（而不是 VEGFR-TKIs）在这一预后不良的患者亚组中的关键作用。最后，前瞻性评估了 cabozantinib 作为 ICI 联合治疗进展后的二线治疗的活性。2023 年 ASCO 泌尿生殖系统癌症研讨会为进一步发展知识奠定了基础，这对于越来越个性化的 mRCC 管理是必要的。
