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Petrelli F, Vavassori I, Rossitto M, Dottorini L. Management of Metastatic Renal Cell Carcinoma Following First-Line Immune Checkpoint Therapy Failure: A Systematic Review. Cancers (Basel) 2024; 16:2598. [PMID: 39061236 PMCID: PMC11274494 DOI: 10.3390/cancers16142598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION There is a significant gap in the literature concerning the effective management of second-line therapy for patients with metastatic renal cell carcinoma (RCC) who have received immune checkpoint inhibitors (ICIs). Most of the published articles were small multicenter series or phase 2 studies. To our knowledge, a systematic review that comprehensively outlines the range of treatment options available for patients with metastatic RCC who do not respond to first-line ICIs has not yet been conducted. Our aim was to synthesize evidence on second-line therapies for patients with metastatic RCC after initial treatment with ICIs and to offer recommendations on the best treatment regimens based on the current literature. MATERIAL AND METHODS We conducted a search in PubMed, Embase, and the Cochrane Library on 29 February 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We selected articles that met the predetermined inclusion criteria (written in English, retrospective observational studies, prospective series, and randomized trials reporting second-line therapy for metastatic RCC after failure of ICI-based therapy). Relevant articles were identified in the reference lists. The main endpoint was the overall response rate (ORR), with the median progression-free survival (PFS) and overall survival (OS) as secondary endpoints. RESULTS We included 27 studies reporting the outcomes of 1970 patients. Salvage therapies were classified as targeted therapy (VEGFR TKIs) in 18 studies and ICIs in 8 studies. In studies where TKIs were the second line of choice, the pooled ORR was 34% (95% CI: 30.2-38%). In studies where ICIs, alone or in combination with TKIs, were used as second-line therapies, the ORR was 25.7% (95% CI: 15.7-39.2%). In studies where TKIs and ICIs were the second-line choices, the pooled median PFS values were 11.4 months (95% CI: 9.5-13.6 months) and 9.8 months (95% CI: 7.5-12.7 months), respectively. CONCLUSIONS This systematic review shows that VEGFR TKIs and ICIs are effective second-line therapies following an initial treatment with anti-PD(L)1 alone or in combination. The treatment choice should be personalized, taking into account the patient's response to first-line ICIs, the site of the disease, the type of first-line combination (with or without VEGFR TKIs), and the patient's overall condition.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, BG, Italy
| | - Ivano Vavassori
- Urology Unit, ASST Bergamo Ovest, 24047 Treviglio, BG, Italy
| | - Mauro Rossitto
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, BG, Italy
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Hamamoto S, Tasaki Y, Morikawa T, Naiki T, Etani T, Taguchi K, Iwatsuki S, Unno R, Takeda T, Nagai T, Kawase K, Mimura Y, Sugiyama Y, Okada A, Furukawa-Hibi Y, Yasui T. Efficacy and Safety of Immuno-Oncology Plus Tyrosine Kinase Inhibitors as Late-Line Combination Therapy for Patients with Advanced Renal Cell Carcinoma. J Clin Med 2024; 13:3365. [PMID: 38929893 PMCID: PMC11204304 DOI: 10.3390/jcm13123365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Immuno-oncology plus tyrosine kinase inhibitor (IO+TKI) combination therapy is an essential first-line therapy for advanced renal cell carcinoma (RCC). However, reports of its efficacy and safety as late-line therapy are lacking. This study aimed to examine the efficacy and safety of IO+TKI combination therapy as a late-line therapy for patients with RCC. Methods: We retrospectively examined 17 patients with RCC who received IO+TKI combination therapy as a second-line therapy or beyond (pembrolizumab plus axitinib, n = 10; avelumab plus axitinib, n = 5; nivolumab plus cabozantinib, n = 2). Results: The overall response and disease control rates of IO+TKI combination therapy were 29.4% and 64.7%, respectively. The median overall survival was not attained. Progression-free survival was 552 days, and 94.1% of patients (n = 16) experienced adverse effects (AEs) of any grade; moreover, 41.2% of patients (n = 7) experienced grade ≥ 3 immuno-related AEs. Conclusions: IO+TKI combination therapy may be a late-line therapy option for RCC.
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Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Yoshihiko Tasaki
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (Y.T.); (Y.M.); (Y.S.); (Y.F.-H.)
| | - Toshiharu Morikawa
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Taku Naiki
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Toshiki Etani
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Kazumi Taguchi
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Shoichiro Iwatsuki
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Rei Unno
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Tomoki Takeda
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Takashi Nagai
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Kengo Kawase
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Yoshihisa Mimura
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (Y.T.); (Y.M.); (Y.S.); (Y.F.-H.)
| | - Yosuke Sugiyama
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (Y.T.); (Y.M.); (Y.S.); (Y.F.-H.)
| | - Atsushi Okada
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
| | - Yoko Furukawa-Hibi
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (Y.T.); (Y.M.); (Y.S.); (Y.F.-H.)
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (T.M.); (T.N.); (T.E.); (K.T.); (S.I.); (R.U.); (T.T.); (T.N.); (K.K.); (A.O.); (T.Y.)
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Samuelly A, Di Stefano RF, Turco F, Delcuratolo MD, Pisano C, Saporita I, Calabrese M, Carfì FM, Tucci M, Buttigliero C. Navigating the ICI Combination Treatment Journey: Patterns of Response and Progression to First-Line ICI-Based Combination Treatment in Metastatic Renal Cell Carcinoma. J Clin Med 2024; 13:307. [PMID: 38256441 PMCID: PMC10816933 DOI: 10.3390/jcm13020307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
The use of immune checkpoint inhibitors (ICIs) in combination with tyrosine kinase inhibitors or other ICIs has significantly improved the prognosis for patients with mccRCC. This marks a major milestone in the treatment of mccRCC. Nonetheless, most patients will discontinue first-line therapy. In this narrative review, we analyze the different patterns of treatment discontinuation in the four pivotal phase III trials that have shown an improvement in overall survival in mccRCC first-line therapy, starting from 1 January 2017 to 1 June 2023. We highlight the different discontinuation scenarios and their influences on subsequent treatment options, aiming to provide more data to clinicians to navigate a complex decision-making process through a narrative review approach. We have identified several causes for discontinuations for patients treated with ICI-based combinations, such as interruption for drug-related adverse events, ICI treatment completion, treatment discontinuation due to complete response or maximum clinical benefit, or due to progression (pseudoprogression, systemic progression, and oligoprogression); for each case, an extensive analysis of the trials and current medical review has been conducted.
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Affiliation(s)
- Alessandro Samuelly
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Rosario Francesco Di Stefano
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Fabio Turco
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Marco Donatello Delcuratolo
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Chiara Pisano
- Department of Medical Oncology, S. Croce e Carle Hospital, 12100 Cuneo, Italy;
| | - Isabella Saporita
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Mariangela Calabrese
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Federica Maria Carfì
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
| | - Marcello Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Consuelo Buttigliero
- Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (A.S.); (F.T.); (I.S.); (M.C.)
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