TY - JOUR
T1 - The 2021 Updated European Association of Urology Guidelines on Renal Cell Carcinoma
T2 - Immune Checkpoint Inhibitor–based Combination Therapies for Treatment-naive Metastatic Clear-cell Renal Cell Carcinoma Are Standard of Care
AU - Bedke, Jens
AU - Albiges, Laurence
AU - Capitanio, Umberto
AU - Giles, Rachel H.
AU - Hora, Milan
AU - Lam, Thomas B.
AU - Ljungberg, Börje
AU - Marconi, Lorenzo
AU - Klatte, Tobias
AU - Volpe, Alessandro
AU - Abu-Ghanem, Yasmin
AU - Dabestani, Saeed
AU - Pello, Sergio Fernández
AU - Hofmann, Fabian
AU - Kuusk, Teele
AU - Tahbaz, Rana
AU - Powles, Thomas
AU - Bex, Axel
N1 - Publisher Copyright:
© 2021 European Association of Urology
PY - 2021/10/1
Y1 - 2021/10/1
N2 - The recent randomized controlled phase III CLEAR trial results are the last to complement immune checkpoint inhibitor (ICI)-based doublet combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma. The CLEAR trial demonstrated an improved progression-free survival (PFS), overall survival (OS), and an objective response rate (ORR) benefit for the combination of lenvatinib plus pembrolizumab over sunitinib. The CheckMate-9ER trial update demonstrated an ongoing PFS, OS, and quality-of-life benefit for cabozantinib plus nivolumab over sunitinib as did the update of Keynote-426 for axitinib plus pembrolizumab in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups. In the IMDC intermediate- and poor-risk groups, the CheckMate-214 trial of ipilimumab plus nivolumab confirmed the OS benefit with a PFS plateauing after 30 months. The RCC Guidelines Panel recommends three tyrosine kinase inhibitors + ICI combinations of axitinib plus pembrolizumab, cabozantinib plus nivolumab, and lenvatinib plus pembrolizumab across all IMDC risk groups in advanced first-line RCC, and dual immunotherapy of ipilimumab and nivolumab in IMDC intermediate- and poor-risk groups. Patient summary: New data from combination trials with immune checkpoint inhibitors for advanced kidney cancer confirm a survival benefit for lenvatinib plus pembrolizumab, cabozantinib plus nivolumab (with improved quality-of-life), axitinib plus pembrolizumab, and ipilimumab plus nivolumab. These combination therapies are recommended as first-line treatment for advanced kidney cancer.
AB - The recent randomized controlled phase III CLEAR trial results are the last to complement immune checkpoint inhibitor (ICI)-based doublet combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma. The CLEAR trial demonstrated an improved progression-free survival (PFS), overall survival (OS), and an objective response rate (ORR) benefit for the combination of lenvatinib plus pembrolizumab over sunitinib. The CheckMate-9ER trial update demonstrated an ongoing PFS, OS, and quality-of-life benefit for cabozantinib plus nivolumab over sunitinib as did the update of Keynote-426 for axitinib plus pembrolizumab in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups. In the IMDC intermediate- and poor-risk groups, the CheckMate-214 trial of ipilimumab plus nivolumab confirmed the OS benefit with a PFS plateauing after 30 months. The RCC Guidelines Panel recommends three tyrosine kinase inhibitors + ICI combinations of axitinib plus pembrolizumab, cabozantinib plus nivolumab, and lenvatinib plus pembrolizumab across all IMDC risk groups in advanced first-line RCC, and dual immunotherapy of ipilimumab and nivolumab in IMDC intermediate- and poor-risk groups. Patient summary: New data from combination trials with immune checkpoint inhibitors for advanced kidney cancer confirm a survival benefit for lenvatinib plus pembrolizumab, cabozantinib plus nivolumab (with improved quality-of-life), axitinib plus pembrolizumab, and ipilimumab plus nivolumab. These combination therapies are recommended as first-line treatment for advanced kidney cancer.
KW - Cabozantinib
KW - Clear-cell
KW - First-line
KW - Lenvatinib, pembrolzumab, nivolumab
KW - Renal cell carcinoma
KW - Systemic therapy
KW - Treatment-naive
UR - http://www.scopus.com/inward/record.url?scp=85107068841&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2021.04.042
DO - 10.1016/j.eururo.2021.04.042
M3 - Editorial
C2 - 34074559
AN - SCOPUS:85107068841
SN - 0302-2838
VL - 80
SP - 393
EP - 397
JO - European Urology
JF - European Urology
IS - 4
ER -