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Review

The Changing Therapeutic Landscape of Metastatic Renal Cancer

1
Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, 28043 Madrid, Spain
2
SUNY Upstate Medical University, Upstate University Hospital, Syracuse, NY 13210, USA
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(9), 1227; https://doi.org/10.3390/cancers11091227
Received: 23 July 2019 / Revised: 19 August 2019 / Accepted: 19 August 2019 / Published: 22 August 2019
(This article belongs to the Special Issue Renal Cell Carcinoma)
The practising clinician treating a patient with metastatic clear cell renal cell carcinoma (CCRCC) faces a difficult task of choosing the most appropriate therapeutic regimen in a rapidly developing field with recommendations derived from clinical trials. NCCN guidelines for kidney cancer initiated a major shift in risk categorization and now include emerging treatments in the neoadjuvant setting. Updates of European Association of Urology clinical guidelines also include immune checkpoint inhibition as the first-line treatment. Randomized trials have demonstrated a survival benefit for ipilimumab and nivolumab combination in the intermediate and poor-risk group, while pembrolizumab plus axitinib combination is recommended not only for unfavorable disease but also for patients who fit the favorable risk category. Currently vascular endothelial growth factor (VEGF) targeted therapy based on tyrosine kinase inhibitors (TKI), sunitinib and pazopanib is the alternative regimen for patients who cannot tolerate immune checkpoint inhibitors (ICI). Cabozantinib remains a valid alternative option for the intermediate and high-risk group. For previously treated patients with TKI with progression, nivolumab, cabozantinib, axitinib, or the combination of ipilimumab and nivolumab appear the most plausible alternatives. For patients previously treated with ICI, any VEGF-targeted therapy, not previously used in combination with ICI therapy, seems to be a valid option, although the strength of this recommendation is weak. The indication for cytoreductive nephrectomy (CN) is also changing. Neoadjuvant systemic therapy does not add perioperative morbidity and can help identify non-responders, avoiding unnecessary surgery. However, the role of CN should be investigated under the light of new immunotherapeutic interventions. Also, markers of response to ICI need to be identified before the optimal selection of therapy could be determined for a particular patient. View Full-Text
Keywords: renal cell carcinoma; immune checkpoint inhibitors; tyrosine kinase inhibitors; efficacy; toxicity; cytoreductive nephrectomy renal cell carcinoma; immune checkpoint inhibitors; tyrosine kinase inhibitors; efficacy; toxicity; cytoreductive nephrectomy
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MDPI and ACS Style

Angulo, J.C.; Shapiro, O. The Changing Therapeutic Landscape of Metastatic Renal Cancer. Cancers 2019, 11, 1227. https://doi.org/10.3390/cancers11091227

AMA Style

Angulo JC, Shapiro O. The Changing Therapeutic Landscape of Metastatic Renal Cancer. Cancers. 2019; 11(9):1227. https://doi.org/10.3390/cancers11091227

Chicago/Turabian Style

Angulo, Javier C., and Oleg Shapiro. 2019. "The Changing Therapeutic Landscape of Metastatic Renal Cancer" Cancers 11, no. 9: 1227. https://doi.org/10.3390/cancers11091227

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