Managing Metastatic Renal Cell Carcinoma after Progression on Immunotherapy

Regina Barragan-Carrillo; Ameish Govindarajan; Adam Rock; Rubens C Sperandio; Sumanta K Pal

doi:10.1016/j.hoc.2023.05.005

Managing Metastatic Renal Cell Carcinoma after Progression on Immunotherapy

Hematol Oncol Clin North Am. 2023 Oct;37(5):965-976. doi: 10.1016/j.hoc.2023.05.005. Epub 2023 Jun 21.

Authors

Regina Barragan-Carrillo¹, Ameish Govindarajan², Adam Rock³, Rubens C Sperandio⁴, Sumanta K Pal⁵

Affiliations

¹ Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiran", Vasco de Quiroga 15 Tlalpan, Mexico City 14080, Mexico. Electronic address: https://twitter.com/ReginaBarCar.
² Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA. Electronic address: https://twitter.com/AGovindarajanMD.
³ Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
⁴ Centro de Oncologia e Hematologia Einstein Família Dayan-Daycoval, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo, 05652-900, Brasil. Electronic address: https://twitter.com/RCSperandio.
⁵ Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA. Electronic address: spal@coh.org.

PMID: 37353376
DOI: 10.1016/j.hoc.2023.05.005

Abstract

Treatment of metastatic renal cell carcinoma (mRCC) after first-line immune checkpoint inhibitors (ICIs) lacks standardization, with limited evidence from small trials and retrospective data. Vascular endothelial growth factor receptor (VEGFR) inhibition through tyrosine kinase inhibitors (TKIs) is the most widely adopted second-line treatment. Encouraging results have been seen with VEGFR-TKIs in the second-line after exposure to an ICI-based combination, achieving a response rate of 30%, and 75% of patients achieving disease control. Rechallenge with ICI alone seems safe but has limited clinical benefit. Promising regimens with combination therapies and novel drugs are being evaluated in phase 3 trials.

Keywords: Immunotherapy; Renal cell carcinoma; Targeted therapy.

Publication types

Review

MeSH terms

Carcinoma, Renal Cell* / drug therapy
Carcinoma, Renal Cell* / pathology
Humans
Immunotherapy / methods
Kidney Neoplasms* / drug therapy
Protein Kinase Inhibitors / pharmacology
Protein Kinase Inhibitors / therapeutic use
Retrospective Studies
Vascular Endothelial Growth Factor A

Substances

Vascular Endothelial Growth Factor A
Protein Kinase Inhibitors