Abstract
Metastatic renal cell carcinoma (RCC) remains largely incurable. Up to 30% of patients show metastasis at the time of the initial diagnosis. Prognostic criteria developed by the IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) and MSKCC (Memorial Sloan Kettering Cancer Center) are used to classify patients based on certain pretreatment factors. The prognosis of patients with metastatic disease varies depending on these risk factors. Anti-angiogenic agents targeting the vascular endothelial growth factor (VEGF) and its receptors are standard treatments based on improved clinical outcomes in randomized phase III trials. Standard of care therapies now include multitargeted tyrosine kinase inhibitors (TKIs) such as sunitinib, axitinib, pazopanib, and cabozantinib, as well as the mTOR inhibitors temsirolimus and everolimus.
Tumor-associated PD-L1 expression has been detected in RCC and is associated with a worse prognosis. Immune checkpoint inhibitors such as the PD-1 inhibitor nivolumab have shown promising results in treatment of the metastatic disease. Future developments including novel combinations and attempts to find the optimal position of immunotherapy in the disease pathway are subject of ongoing clinical trials.
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Rübben, H., Panic, A. (2019). Anti-angiogenics in Kidney Cancer Therapy. In: Marmé, D. (eds) Tumor Angiogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-31215-6_27-1
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DOI: https://doi.org/10.1007/978-3-319-31215-6_27-1
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