摘要
We aim to describe the most recent advances in the upfront treatment of metastatic renal cell carcinoma,and to provide criteria-though often subjective-which could be used for treatment selection,by means of a critical review of the results of novel trials of immune-based combinations,coupled with personal considerations and experiences.To date,5 immune-based combinations have been tested within large phase III trials;four of them yielded a significant overall survival benefit(Ipilimumab+Nivolumab,Pembrolizumab+Axitinib,Nivolumab+Cabozantinib and Pembrolizumab+Lenvatinib),while the combination of Avelumab+Axitinib,although reaching study primary endpoint,determined just a significant progression-free survival benefit.In terms of safety,the excess of adverse events is overall counterbalanced to the higher activity of the combinations.Overall,all the discussed immune-based combinations were ultimately approved by different regulatory authorities,and are indeed included in the most important international guidelines.Waiting for longer follow-ups and more mature trial data,as well as for real-world experiences,in the absence of validated biomarkers,our 1st line treatment choice cannot but rely on methodologically incorrect treatment comparisons,personal preferences,and experience.
