Page 54 - Read Online

Porta et al. J Cancer Metastasis Treat 2021;7:49 Journal of Cancer
DOI: 10.20517/2394-4722.2021.86
Metastasis and Treatment

Review Open Access

Recent advances in the frontline treatment of
metastatic renal cell carcinoma

1,2
Camillo Porta , Mimma Rizzo 3
1
Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’, Bari 70124, Italy.
2
Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari 70124, Italy.
3
Division of Translational Oncology, I.R.C.C.S. Istituti Clinici Scientifici Maugeri, Pavia 27100, Italy.
Correspondence to: Prof. Camillo Porta, Chair of Oncology, Department of Biomedical Sciences and Human Oncology,
University of Bari ‘A. Moro’, and Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Piazza Giulio Cesare 11,
70124 Bari, Italy. E-mail: camillo.porta@gmail.com

How to cite this article: Porta C, Rizzo M. Recent advances in the frontline treatment of metastatic renal cell carcinoma. J Cancer
Metastasis Treat 2021;7:49. https://dx.doi.org/10.20517/2394-4722.2021.86

Received: 1 Apr 2021 First Decision: 21 May 2021 Revised: 30 May 2021 Accepted: 9 Jun 2021 First online: 4 Jul 2021

Academic Editors: Lucio Miele, Hendrik P.A.M. Van-Poppel Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
We aim to describe the most recent advances in the upfront treatment of metastatic renal cell carcinoma, and to
provide criteria - though often subjective - which could be used for treatment selection, by means of a critical
review of the results of novel trials of immune-based combinations, coupled with personal considerations and
experiences. To date, 5 immune-based combinations have been tested within large phase III trials; four of them
yielded a significant overall survival benefit (Ipilimumab + Nivolumab, Pembrolizumab + Axitinib, Nivolumab +
Cabozantinib and Pembrolizumab + Lenvatinib), while the combination of Avelumab + Axitinib, although reaching
study primary endpoint, determined just a significant progression-free survival benefit. In terms of safety, the
excess of adverse events is overall counterbalanced to the higher activity of the combinations. Overall, all the
discussed immune-based combinations were ultimately approved by different regulatory authorities, and are
indeed included in the most important international guidelines. Waiting for longer follow-ups and more mature trial
data, as well as for real-world experiences, in the absence of validated biomarkers, our 1st line treatment choice
cannot but rely on methodologically incorrect treatment comparisons, personal preferences, and experience.

Keywords: Renal cell carcinoma, immune checkpoint inhibitors, antiangiogenics, survival

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.jcmtjournal.com