Abstract
In the last decades, the prognosis of metastatic renal cell carcinoma (mRCC) has remarkably improved following the advent of the “targeted therapy” era. The expanding knowledge on the prominent role played by angiogenesis in RCC pathogenesis has led to approval of multiple anti-angiogenic agents such as sunitinib, pazopanib, axitinib, cabozantinib, sorafenib, and bevacizumab. These agents can induce radiological responses and delay cancer progression for months or years before onset of resistance, with a clinically meaningful activity. The need for markers of prognosis and efficacy of anti-angiogenic agents has become more compelling as novel systemic immunotherapy agents have also been approved in RCC and can be administered as an alternative to angiogenesis inhibitors. Anti PD-1 monoclonal antibody nivolumab has been approved in the second-line setting after tyrosine kinase inhibitors failure, while combination of nivolumab plus anti CTLA-4 monoclonal antibody ipilimumab has been approved as first-line therapy of RCC patients at intermediate or poor prognosis. In this review article, biomarkers of prognosis and efficacy of antiangiogenic therapies are summarized with a focus on those that have the potential to affect treatment decision-making in RCC. Biomarkers predictive of toxicity of anti-angiogenic agents have also been discussed.
Highlights
Renal cell carcinoma (RCC) is the seventh most frequently diagnosed malignancy in men and the ninth in women, representing ∼2–3% of cancer diagnoses in adults [1]
This review provides a comprehensive appraisal of prognostic and predictive factors tested in patients with Clear cell RCC (ccRCC) treated with anti-angiogenic agents, with a focus on those with a potential to affect therapeutic decisions—for example, the choice of an antiangiogenic vs. an immunotherapy agent
The importance of such a prognostic classification lies in its implications for treatment choice, as temsirolimus is approved only in patients at poor prognosis and novel immunotherapy combination ipilimumab plus nivolumab is approved in patients at intermediate and poor prognosis [22,23,24,25,26,27,28,29,30,31]
Summary
Renal cell carcinoma (RCC) is the seventh most frequently diagnosed malignancy in men and the ninth in women, representing ∼2–3% of cancer diagnoses in adults [1]. Metastatic Renal Cancer Biomarkers and Treatment carcinomas (1–2%), and translocation-associated RCC (
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