Therapeutic alternatives to treat metastatic renal cell carcinoma (mRCC) are increasing, and combination therapies, including antiangiogenic agents and tyrosine kinase/mTOR/immune checkpoint inhibitors, are identified as the gold standard driven by the results of recent clinical studies. Nevertheless, the real-world RCC population is very heterogeneous, with categories of patients not represented in the enrolled trial population who may not benefit more from these treatments. The purpose of this expert review is to assess the rationale on which tyrosine kinase alone may still be a viable first-line treatment option for some subgroups of patients with mRCC.
The first-line treatment with tyrosine kinase inhibitor monotherapy can still be considered an effective tool for addressing selected mRCCs, as highlighted by the successful outcome in a range of subjects such as favorable-risk patients, the ones suffering from autoimmune diseases, those with pancreatic or lung metastases, or previously undergoing organ transplantation and elderly subjects. Some selected categories of patients may still benefit from monotherapy with TKI, and smart sequential therapies can also be considered instead of a combination strategy. Tyrosine kinase inhibitors can also act as immune modulator agents, boosting the immune response to facilitate and potentiate the therapeutic effectiveness of subsequent immunotherapy.
Current oncology reports. 2021 Nov 08*** epublish ***
Ernesto Rossi, Melissa Bersanelli, Alain Jonathan Gelibter, Nicolò Borsellino, Claudia Caserta, Laura Doni, Marco Maruzzo, Alessandra Mosca, Carmela Pisano, Elena Verzoni, Paolo Andrea Zucali
Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. ., Medicine and Surgery Department, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Medical Oncology Unit B, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy., Medical Oncology, Buccheri La Ferla - Fatebenefratelli Hospital, Palermo, Italy., Medical and Translational Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy., Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy., Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy., Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy., Medical Oncology, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.