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.
Journal of clinical medicine. 2024 Jan 05*** epublish ***
Alessandro Samuelly, Rosario Francesco Di Stefano, Fabio Turco, Marco Donatello Delcuratolo, Chiara Pisano, Isabella Saporita, Mariangela Calabrese, Federica Maria Carfì, Marcello Tucci, Consuelo Buttigliero
Department of Medical Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy., Department of Medical Oncology, S. Croce e Carle Hospital, 12100 Cuneo, Italy., Department of Medical Oncology, Cardinal Massaia Hospital, 14100 Asti, Italy.