Renal cell carcinoma (RCC) comprises a highly heterogeneous group of kidney tumours built upon distinct genetic- and epigenetic-driven mechanisms and molecular pathways. Therefore, responsiveness to treatment is considerably variable across patients, adding an extra layer of complexity to the already challenging therapeutic decision process. The last decade brought an unprecedented shift in the medical approach to advanced or metastatic RCC; in fact, immunotherapy-based combinations have significantly transformed the therapeutic arsenal and clinical outcomes of these patients. These strategies were quickly adopted by international guidelines committees as the new standards of care. However, this enhanced efficacy comes at the expense of tolerability, with a predictable negative impact on patients' quality of life. Moreover, subgroup and post hoc analyses of the major clinical trials have shown that not all patients benefit equally from these innovative approaches. In this context, a group of experts on kidney cancer met and discussed the state of the art in the field, with a special emphasis on the appropriateness of using monotherapy with an anti-angiogenesis tyrosine kinase inhibitor (TKI) to treat specific subgroups of patients with RCC. This article reviews the main topics that were considered to be pertinent for that discussion and establishes the profile of patients for whom TKI monotherapy remains a sensible frontline option by avoiding overtreatment and an unnecessary exposure to treatment-related toxicity.
Advances in therapy. 2022 Jan 13 [Epub ahead of print]
Mário Fontes-Sousa, Helena Magalhães, Alicia Oliveira, Filipa Carneiro, Filipa Palma Dos Reis, Pedro Silvestre Madeira, Sara Meireles
Hospital CUF Tejo, Av. 24 Julho, 171A, 1350-352, Lisbon, Portugal. ., Hospital Pedro Hispano (Unidade Local de Saúde de Matosinhos), Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Portugal., Hospital do Espírito Santo de Évora, Largo do Sr. da Pobreza, 7000-811, Évora, Portugal., Medical oncology department, Instituto Português de Oncologia Do Porto, Rua Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal., Hospital de Santo António Dos Capuchos (Centro Hospitalar Universitário de Lisboa Central), Alameda Santo António Dos Capuchos, 1169-050, Lisbon, Portugal., Instituto Português de Oncologia de Coimbra, Av. Prof. Dr. Bissaya Barreto No. 98, 3000-075, Coimbra, Portugal., Hospital de São João (Centro Hospitalar Universitário de São João), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.