Combinations of Anti-Angiogenic Agents and Immune Checkpoint Inhibitors in Renal Cell Carcinoma: Best Option?

Author:

Granet-Vaissiere Estelle1,Lefort Félix1ORCID,Domblides Charlotte123ORCID,Larroquette Mathieu12ORCID,Ravaud Alain12,Bernhard Jean-Christophe24ORCID,Gross-Goupil Marine1

Affiliation:

1. Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France

2. Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France

3. ImmunoConcEpt, CNRS UMR 5164, Bordeaux University, 33076 Bordeaux, France

4. Department of Urology, University Hospital of Bordeaux, 33000 Bordeaux, France

Abstract

Over the past decade, major advances have been made in the treatment of advanced and metastatic renal cell carcinomas, specifically clear cell carcinomas. For many years the optimal approach was sequential; thus, monotherapies [principally tyrosine kinase inhibitors (TKIs)] targeting angiogenesis until toxicity or progressive disease developed. The rationale was the common mechanisms of action of the targeting agents and avoidance of the risk of overlapping toxicities. Immune checkpoint inhibitors (ICIs) are effective monotherapies, and combinations thereof with anti-angiogenic agents were thus later considered. Synergistic interactions were reported in vitro. Clinical efficacy was evident in three pivotal phase III trials with axitinib-pembrolizumab, cabozantinib-nivolumab, and lenvatinib-pembrolizumab combinations. Two other combinations showed interesting results but did not improve overall survival. However, the data aided our understanding of the new therapeutic approaches. A combination of the ICIs nivolumab and ipilimumab was the first to evidence better progression-free and overall survival compared to sunitinib in patients with intermediate or unfavourable prognoses as evaluated by the International mRCC Database Consortium (IMDC). Here we focus on the TKI-ICI combinations, emphasising the rationale of their use and the clinical results. To date, no biomarker facilitating the selection of an optimal treatment by disease and patient status has been reported.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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