舒尼替尼
医学
肾细胞癌
肿瘤科
贝伐单抗
免疫疗法
阿西替尼
背景(考古学)
帕唑帕尼
肾癌
内科学
酪氨酸激酶抑制剂
癌症
化疗
生物
古生物学
作者
Martina Catalano,Giuseppe Procopio,Pierangela Sepe,Matteo Santoni,Francesco Sessa,Donata Villari,Gabriella Nesi,Giandomenico Roviello
标识
DOI:10.1016/j.pharmthera.2023.108499
摘要
Over the past decade, the management of metastatic renal cell carcinoma (RCC) has undergone rapid evolution, culminating in a significant improvement in prognosis with frontline immunotherapy. RCC is a highly immunogenic and pro-angiogenic cancer, and mounting evidence has established the immunosuppressive effects of pro-angiogenic factors on the host's immune system. Anti-angiogenic agents such as tyrosine kinase inhibitors (TKIs) and bevacizumab, which obstruct the vascular endothelial growth factor pathway, have demonstrated the potential to enhance antitumor activity and improve the efficacy of immune checkpoint inhibitors (ICIs). Consequently, various combinations of TKIs and ICIs have been assessed and are currently considered the preferred regimens for all metastatic RCC patients, regardless of their prognostic risk score. Nevertheless, some inquiries have arisen within the medical community, as metastatic RCC patients with favorable risk scores who received ICIs and TKIs in combination showed no statistically significant advantage in overall survival compared to those treated with sunitinib alone. Considering these concerns, this review aims to elucidate the rationale behind TKI and ICI combination therapies, provide a summary of current first-line metastatic RCC combinations approved for use, with a focus on favorable-risk patients, and outline present challenges and future perspectives in this context.
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