晚期肾癌的免疫治疗进展与述评

Progress and Comment on Immunotherapy of Advanced Renal Cell Carcinoma

随着纳武单抗(Nivolumab)被写进晚期肾癌二线治疗指南,免疫治疗再次回到晚期肾癌的治疗领域并取得成功。免疫治疗单药一线治疗的疗效有限,因而免疫联合抗血管靶向治疗成为目前的主要进展。近年来,几项大型Ⅲ期随机对照研究先后公布研究结果。Nivolumab和伊匹单抗(Ipililmumab)的免疫联合免疫治疗推荐用于中高危晚期肾癌患者。免疫联合抗血管靶向治疗中帕博利珠单抗(Pembrolizumab)联合阿昔替尼(Axitinib)以及阿维鲁单抗(Avelumab)联合Axitinib也写入指南。如何选择免疫治疗的合适人群,需要结合疾病特征、危险分层和社会经济学综合考虑,并探索合适的生物预测标志物。

Immunotherapy has made great progress in the treatment of advanced renal cell carcinoma(RCC),since nivolumab was approved for the second-line therapy of advanced RCC.The efficacy of anti-PD1 monotherapy was limited in the first-line setting,therefore the combination of immunotherapy and anti-angiogenesis targeted therapy is becoming the trend.As the release of several randomized phaseⅢclinical trials results,ipilimumab in combination with nivolumab is recommended for intermediate-/highrisk advanced RCC.Pembrolizumab plus axitinib or avelumab plus axitinib are proved to be more efficacious than traditional targeted therapy.How to select the appropriate population for immunotherapy depends on individual characteristics,disease risk,social economics and appropriate prognostic biomarkers.