演題抄録

基調講演

開催概要
開催回
第56回・2018年・横浜
 

Advance in the treatment of mRCC

演題番号 : KL8

[筆頭演者]
演者)Jun Guo:1 

1:Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, China

 

There has been significant progress in the treatment of patients with advanced clear cell renal cell carcinoma (ccRCC), with improved knowledge of disease biology and the introduction of targeted agents and immunotherapies. In this review, we discuss current and emerging first-line treatment options, including recent approvals of the tyrosine kinase inhibitor (TKI) cabozantinib and the immunotherapy combination of nivolumab (anti-programmed cell death 1 [PD-1])/ipilimumab (anti-cytotoxic T-lymphocyte-associated antigen 4 [CTLA-4]), and initial outcomes with the combination of atezolizumab (anti-PD-ligand 1 [PD-L1])/bevacizumab (anti-vascular endothelial growth factor [VEGF]). Key clinical data are reviewed, as these novel first-line treatments offer significant improvement, particularly for patients classified as intermediate/poor risk for whom previously available therapies have demonstrated limited efficacy. Treatment recommendations based on clinical evidence and expert opinion are discussed. We also review ongoing studies investigating combinations of checkpoint inhibitors with TKIs, including cabozantinib and axitinib, and with other novel immunomodulatory agents, and the potential role of single-agent immunotherapy for select patients. With a growing treatment armamentarium, identification and validation of biomarkers will be crucial for optimizing selection and treatment sequences. For second-line therapy, except everolimus and axitinib, three novel therapies have been recently approved for use that further advance the treatment armamentarium: nivolumab, cabozantinib, and lenvatinib in combination with everolimus. For non-clear-cell RCC, clinicians are still lack of some robust data, especially for some rare subtypes. Collecting duct carcinoma (CDC) is a rare type of renal cancer with a poor prognosis. Combined therapies of sorafenib, gemcitabine,plus cisplatin in patients with mCDC in a phase 2 trial showed that the 6-month PFS rate was 65%, and the median PFS was 8.8 months with a median overall survival of about 12.5 months. In the future, combination therapy with immunoagents like anti-PD-1/anti-PD-L1 inhibitors and radiotherapy, chemotherapy, or targeted therapy will be the mainstream to increase the response rate and prolong the patients’ survival.

前へ戻る