Abstract
Immunotherapy has changed the therapeutic scenario of metastatic renal cell carcinoma (mRCC), however the evaluation of disease response to immune-checkpoint inhibitors is still an open challenge. Response evaluation criteria in solid tumors (RECIST) 1.1 criteria are the cornerstone of response assessment to anti-neoplastic treatments, but the use of anti-programmed death receptor 1 (PD1) and other immunotherapeutic agents has shown atypical patterns of response such as pseudoprogression. Therefore, immune-modified criteria have been developed in order to more accurately categorize the disease response, even though their use in the everyday clinical practice is still limited. In this review we summarize the available evidence on this topic, with particular focus on the application of immune-modified criteria in the setting of mRCC.
Highlights
Renal cell carcinoma (RCC) represents about 3% of solid tumors worldwide, with an estimated incidence of approximately 330,000 new cases per year
The incidence of pseudoprogression has been described in approximately 10% of patients with metastatic melanoma treated with anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) and anti-programmed death receptor 1 (PD1) antibodies [41,42,43], whereas the frequency in other tumor settings is unclear, even though, in metastatic RCC (mRCC), recent data derived from patients treated beyond progression in the clinical trials report a comparable result, with a rate of about 5–15% [44,45]
The -defined unidimensional Immune-Related Response Criteria (irRC) criteria were retrospectively evaluated in a dataset of non-small cell lung cancer (NSCLC) patients treated with nivolumab, evidencing identical response rate and longer time to progression as compared with Response evaluation criteria in solid tumors (RECIST) 1.1 criteria, and in advanced melanoma patients treated with pembrolizumab, showing a low rate of patients experiencing pseudoprogression and that a
Summary
Renal cell carcinoma (RCC) represents about 3% of solid tumors worldwide, with an estimated incidence of approximately 330,000 new cases per year. The IMmotion151 [17] trial reported that the combination of the anti-PD-L1 atezolizumab plus bevacizumab prolonged PFS versus sunitinib, and the KEYNOTE-426 [16] study showed a significant benefit in terms of OS, PFS and ORR for the anti-PD1 agent pembrolizumab plus axitinib as compared to sunitinib. In light of these data, the therapeutic scenario of mRCC is rapidly changing, but, several unmet needs remain in this setting. In this review we describe the available tools to categorize the tumor response to immunotherapeutic agents and we summarize the evidence collected on this topic with a specific focus on mRCC
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