ESMO guidelines on renal cell carcinoma: the paradox of the fine line that separates scientific robustness from cost-efficiency analysis

Abstract

If someone had told us at the beginning of the century that we would have up to 15 different drugs approved for the systemic treatment of patients with metastatic renal cell cancer (mRCC) in 2022, we would not have believed them. 1 https://www.cancer.gov/about-cancer/treatment/drugs/kidneyDate accessed: September 26, 2021 Google Scholar The understanding of the molecular bases of angiogenesis and then the use of vascular endothelial growth factor receptor (VEGFR) and mammalian target of rapamycin (mTOR) inhibitors, allowed us to leave behind the long period of cytokines. 2 Hsieh J.J. Purdue M.P. Signoretti S. et al. Renal cell carcinoma. Nat Rev Dis Primers. 2017; 3: 17009 Crossref PubMed Scopus (1007) Google Scholar During this time, we have learned how to sequence drugs, deal with new toxicities, and how to handle doses and treatment schedules. This was the first step to improve the survival of our mRCC patients. 3 Dutcher J.P. Flippot R. Fallah J. Escudier B. On the shoulders of giants: the evolution of renal cell carcinoma treatment-cytokines, targeted therapy, and immunotherapy. Am Soc Clin Oncol Educ Book. 2020; 40: 1-18 PubMed Google Scholar ,4 Escudier B. Szczylik C. Porta C. Gore M. Treatment selection in metastatic renal cell carcinoma: expert consensus. Nat Rev Clin Oncol. 2012; 9: 327-337 Crossref PubMed Scopus (115) Google Scholar With the understanding of the role of immune checkpoints, and further the approval of different combinations based on immune checkpoint inhibitors, we reached another step of improvement. 5 Escudier B. Pluzanska A. Koralewski P. et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet. 2007; 370: 2103-2111 Abstract Full Text Full Text PDF PubMed Scopus (1999) Google Scholar , 6 Rini B.I. Halabi S. Rosenberg J.E. et al. Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol. 2008; 26: 5422-5428 Crossref PubMed Scopus (789) Google Scholar , 7 Motzer R.J. Tannir N.M. McDermott D.F. et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med. 2018; 378: 1277-1290 Crossref PubMed Scopus (2211) Google Scholar , 8 Motzer R.J. Penkov K. Haanen J. et al. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019; 380: 1103-1115 Crossref PubMed Scopus (1154) Google Scholar , 9 Rini B.I. Plimack E.R. Stus V. et al. Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019; 380: 1116-1127 Crossref PubMed Scopus (1450) Google Scholar , 10 Choueiri T.K. Powles T. Burotto M. et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2021; 384: 829-841 Crossref PubMed Scopus (362) Google Scholar , 11 Motzer R. Alekseev B. Rha S.Y. et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med. 2021; 384: 1289-1300 Crossref PubMed Scopus (344) Google Scholar , 12 Rini B.I. Powles T. Atkins M.B. et al. Atezolizumab plus bevacizumab versus sunitinib in patients with previously untreated metastatic renal cell carcinoma (IMmotion151): a multicentre, open-label, phase 3, randomised controlled trial. Lancet. 2019; 393: 2404-2415 Abstract Full Text Full Text PDF PubMed Scopus (507) Google Scholar ESMO Clinical Practice Guideline update on the use of immunotherapy in early stage and advanced renal cell carcinomaAnnals of OncologyVol. 32Issue 12PreviewThis article focuses on the recent immunotherapy updates to the treatment of renal cell carcinoma (RCC) as given in the RCC: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.1 Full-Text PDF