TY - JOUR
T1 - The roaring 2020s
T2 - A new decade of systemic therapy for renal cell carcinoma
AU - Srivastava, Arnav
AU - Doppalapudi, Sai K.
AU - Patel, Hiren V.
AU - Srinivasan, Ramaprasad
AU - Singer, Eric A.
N1 - Funding Information:
The current work is supported by the Intramural Research Program of the National Institutes of Health (National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA) and a grant from the National Cancer Institute (P30CA072720).
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Purpose of reviewThe genomic and immunologic profiling of renal cell carcinoma (RCC) has provided the impetus for advancements in systemic treatments using combination therapy - either with immune check point inhibitor (ICI)-+-ICI or with ICI-+-targeted therapy. This approach has been examined in several landmark trials, treating both clear cell (ccRCC) and nonclear cell (nccRCC) histologies. In this review, we highlight systemic therapy advancements made in this new decade, the 2020s.Recent findingsTargeting the programmed death receptor 1/PD-L1 pathway has created more tolerable and effective immunotherapy regimens, expanding the applications of ICIs. These new applications, paired with trial data, include ICI monotherapy in nccRCC and adjuvant pembrolizumab in resected, high-risk RCC. In addition, ICI-+-ICI and ICI-+-TKI combination therapy have demonstrated oncologic efficacy in advanced ccRCC and sarcomatoid RCC. Similar progress has been noted regarding new targeted therapies. Along the hypoxia inducible factor pathway, belzutifan has received FDA approval in von Hippel-Lindau-associated RCC. In addition, in papillary RCC, agents such as cabozantinib target the MET proto-oncogene pathway and have demonstrated impressive oncologic outcomes.SummaryThe 2020s utilize the molecular profiling of advanced RCC as a scaffold for recent trials in immunotherapy and targeted therapies. Going forward, emphasizing patient-reported outcomes and careful clinical trial construction remain critical to improve systemic therapy in RCC.
AB - Purpose of reviewThe genomic and immunologic profiling of renal cell carcinoma (RCC) has provided the impetus for advancements in systemic treatments using combination therapy - either with immune check point inhibitor (ICI)-+-ICI or with ICI-+-targeted therapy. This approach has been examined in several landmark trials, treating both clear cell (ccRCC) and nonclear cell (nccRCC) histologies. In this review, we highlight systemic therapy advancements made in this new decade, the 2020s.Recent findingsTargeting the programmed death receptor 1/PD-L1 pathway has created more tolerable and effective immunotherapy regimens, expanding the applications of ICIs. These new applications, paired with trial data, include ICI monotherapy in nccRCC and adjuvant pembrolizumab in resected, high-risk RCC. In addition, ICI-+-ICI and ICI-+-TKI combination therapy have demonstrated oncologic efficacy in advanced ccRCC and sarcomatoid RCC. Similar progress has been noted regarding new targeted therapies. Along the hypoxia inducible factor pathway, belzutifan has received FDA approval in von Hippel-Lindau-associated RCC. In addition, in papillary RCC, agents such as cabozantinib target the MET proto-oncogene pathway and have demonstrated impressive oncologic outcomes.SummaryThe 2020s utilize the molecular profiling of advanced RCC as a scaffold for recent trials in immunotherapy and targeted therapies. Going forward, emphasizing patient-reported outcomes and careful clinical trial construction remain critical to improve systemic therapy in RCC.
KW - clear cell renal cell carcinoma
KW - hypoxia inducible factor inhibitor
KW - immune checkpoint inhibitors
KW - nonclear cell renal cell carcinoma
KW - systemic therapy
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U2 - 10.1097/CCO.0000000000000831
DO - 10.1097/CCO.0000000000000831
M3 - Review article
C2 - 35266906
AN - SCOPUS:85131770902
SN - 1040-8746
VL - 34
SP - 234
EP - 242
JO - Current Opinion in Oncology
JF - Current Opinion in Oncology
IS - 3
ER -