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RENAL CELL CARCINOMA IN 2018

Radical shifts in the first-line management of metastatic renal cell carcinoma

Nature Reviews Clinical Oncology volume 16, pages 71–72 (2019)Cite this article

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In 2018, the results of multiple phase III trials in metastatic renal cell carcinoma (mRCC) were presented. A phase III noninferiority trial demonstrated the importance of careful patient selection before cytoreductive nephrectomy. Additionally, three randomized phase III trials demonstrated the superiority of combination therapy with an immune-checkpoint inhibitor backbone versus sunitinib in patients with treatment-naive mRCC.

Key advances

  • Careful patient selection is critical for patients with metastatic renal cell carcinoma (mRCC) being considered for cytoreductive nephrectomy and should be discouraged in patients with poor-risk mRCC who have a high burden of extrarenal disease4.

  • A phase III trial comparing ipilimumab and nivolumab versus sunitinib in first-line intermediate-risk and poor-risk mRCC demonstrated an overall survival benefit for patients receiving ipilimumab and nivolumab6.

  • Multiple phase III trials in treatment-naive mRCC demonstrated that the combination of immune-checkpoint inhibitors with VEGF-targeted agents is superior to VEGF-targeted therapy alone7,9.

Before 2018, the surgical and medical management of patients with newly diagnosed metastatic renal cell carcinoma (mRCC) had been largely unchanged for close to a decade1. Cytoreductive nephrectomy (CN) before medical treatment was a common approach in selected patients2,3. A small subset of patients received high-dose IL-2, while the majority received agents targeting the VEGF or mTOR pathways such as sunitinib, pazopanib, cabozantinib and temsirolimus. In 2018, new data were presented that will drastically alter the management of patients with treatment-naive mRCC.

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References

  1. Barata, P. C. & Rini, B. I. Treatment of renal cell carcinoma: current status and future directions. CA Cancer J. Clin. 67, 507–524 (2017).

    Article  Google Scholar 

  2. Flanigan, R. C. et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N. Engl. J. Med. 345, 1655–1659 (2001).

    Article  CAS  Google Scholar 

  3. Heng, D. Y. C. et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur. Urol. 66, 704–710 (2014).

    Article  Google Scholar 

  4. Méjean, A. et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N. Engl. J. Med. 379, 417–427 (2018).

    Article  Google Scholar 

  5. Motzer, R. J. et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N. Engl. J. Med. 373, 1803–1813 (2015).

    Article  CAS  Google Scholar 

  6. Motzer, R. J. et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N. Engl. J. Med. 378, 1277–1290 (2018).

    Article  CAS  Google Scholar 

  7. Motzer, R. J. et al. IMmotion151: a randomized phase III study of atezolizumab plus bevacizumab versus sunitinib in untreated metastatic renal cell carcinoma (mRCC) [abstract]. J. Clin. Oncol. 36 (Suppl. 6), 578 (2018).

    Article  Google Scholar 

  8. Escudier, B. et al. Patient-reported outcomes (PROs) in IMmotion151: atezolizumab (atezo) + bevacizumab (bev) versus sunitinib (sun) in treatment (tx) naive metastatic renal cell carcinoma (mRCC) [abstract]. J. Clin. Oncol. 36 (Suppl. 15), 4511 (2018).

    Article  Google Scholar 

  9. Motzer, R. J. et al. JAVELIN renal 101: a randomized, phase III study of avelumab + axitinib versus sunitinib as first-line treatment of advanced renal cell carcinoma (aRCC) [abstract]. Ann. Oncol. 29 (Suppl. 8), LBA6_PR (2018).

    Google Scholar 

  10. Rini, B. I. et al. Molecular correlates differentiate response to atezolizumab (atezo) + bevacizumab (bev) versus sunitinib (sun): results from a phase III study (IMmotion151) in untreated metastatic renal cell carcinoma (mRCC) [abstract]. Ann. Oncol. 29 (Suppl. 8), LBA31 (2018).

    Google Scholar 

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Authors and Affiliations

  1. Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA

    Moshe C. Ornstein & Brian I. Rini

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  1. Moshe C. Ornstein
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  2. Brian I. Rini
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Correspondence to Brian I. Rini.

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Competing interests

M.C.O. has received fees as a consultant of Bristol-Myers Squibb, Exelixis, Eisai and Pfizer. B.I.R. has received fees as a consultant of Bristol-Myers Squibb, Merck and Pfizer.

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Ornstein, M.C., Rini, B.I. Radical shifts in the first-line management of metastatic renal cell carcinoma. Nat Rev Clin Oncol 16, 71–72 (2019). https://doi.org/10.1038/s41571-018-0146-4

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