Treatment of metastatic сlear cell renal cell carcinoma: focus on a group of patients with favourable prognosis

Abstract

Current clinical guidelines of various domestic and foreign professional communities indicate combination regimens as an option for the first-line therapy for metastatic сlear cell renal cell carcinoma, regardless of the patient’s prognosis group. This review article is devoted to the analysis of the current evidence base for the use of different variants of combination therapy regimens in patients with metastatic renal cell carcinoma and assessment of the role of single-component cancer therapy options in the initial treatment of this disease. We reviewed the results of studies of current immuno-oncology therapy regimens in the first-line renal cell carcinoma therapy with a focus on a favourable prognosis group, taking into account the latest updates from the studies evaluating the efficacy of combination treatments (pembrolizumab/axitinib, pembrolizumab/lenvatinib, nivolumab/cabozantinib, avelumab/axitinib). We found that although the use of certain combinations of immunooncology and targeted drugs give better results of disease control, objective response and progression-free survival rates, none of the studied combinations to date has shown a significant increase in overall patient survival rates, which is a key treatment efficacy indicator in metastatic cancer. Conclusions drawn from this review indicate that monotherapy with tyrosine kinase inhibitors, such as sunitinib or pazopanib, appears to be sufficient and optimal from a clinical and economic point of view in the treatment of a favourable prognosis group. For patients with a favourable prognosis, tyrosine kinase inhibitor monotherapy may be a primary rather than an alternative therapeutic option until the benefit of combinations in terms of overall survival rates has been showed.