The new landscape of treatments for metastatic clear cell renal carcinoma (mRCC) is constantly expanding, but it is associated with the emergence of novel toxicities, adding to up to those observed in the tyrosine-kinase inhibitor (TKI) era. Indeed, the introduction of immune checkpoint inhibitors (ICIs) alone or in combination has been associated with the development of immune-related adverse events (irAEs) involving multiple-organ systems which, even if rarely, had led to fatal outcomes. Moreover, due to the relatively recent addition of ICIs to the previously available treatments, the potential additive adverse effects of these combinations are still unknown. A prompt recognition and management of these toxicities currently represents a fundamental issue in oncology, since it correlates with the outcome of cancer patients. Even if clinical guidelines provide indications for the management of irAEs, no specific protocol to evaluate the individual risk of developing an adverse event during therapy is currently available. A multidisciplinary approach addressing appropriate interventions aimed at reducing the risk of any insidious, severe, and/or dose-limiting toxicity might represent the most efficacious strategy to timely prevent and manage severe irAEs, allowing indirectly to improve both patients' cancer-specific survival and quality of life. In this review, we reported a five-case series of toxicity events that occurred at our center during treatment for mRCC followed by the remarks of physicians from different specialties, pinpointing the relevant role of an integrated and extended multidisciplinary team in a modern model of mRCC patient management.
Frontiers in oncology. 2023 Jan 12*** epublish ***
Michela Roberto, Martina Panebianco, Anna Maria Aschelter, Dorelsa Buccilli, Carmen Cantisani, Salvatore Caponnetto, Enrico Cortesi, Sara d'Amuri, Claudia Fofi, Debora Ierinò, Viviana Maestrini, Paolo Marchetti, Massimo Marignani, Antonio Stigliano, Luca Vivona, Daniele Santini, Silverio Tomao
Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology Unit A, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy., Department of Clinical and Molecular Medicine, Oncology Unit, Sant' Andrea University Hospital, Sapienza University of Rome, Rome, Italy., Department of Dermatology, Complex Operative Unit (UOC) of Dermatology, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy., Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology Unit B, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy., Department of Clinical and Molecular Medicine, Nephrology and Dialysis Unit, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy., Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy., Scientific Direction, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy., Head Liver Disease Section, Digestive and Liver Diseases Department, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy., Department of Clinical and Molecular Medicine, Endocrinology Unit, Sant 'Andrea University Hospital, Sapienza University of Rome, Rome, Italy., Complex Operative Unit (UOC) Oncologia Medica, Sapienza University, Polo Pontino, Latina, Italy.