Combination Therapy as First-Line Treatment in Metastatic Renal-Cell Carcinoma
Menés sur 886 et 861 patients atteints d'un carcinome à cellules rénales de stade avancé, ces deux essais de phase III comparent l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité du sunitinib et d'un traitement de première ligne à base d'axitinib et d'avélumab ou de pembrolizumab
The treatment of metastatic renal-cell carcinoma has been revolutionized twice in the past 12 years by data showing that vascular endothelial growth factor (VEGF) inhibition can induce tumor shrinkage and increase progression-free survival and that immune checkpoint inhibitors can induce durable responses and increase overall survival among patients with this form of cancer. Guidelines for the treatment of metastatic renal-cell carcinoma have changed dramatically to recommend agents that target these two major pathways. In 2007, a trial showed that sunitinib, a tyrosine kinase inhibitor with potent VEGF inhibition, was superior to interferon alfa, and sunitinib became a new standard of care as a first-line therapy.1 In 2015, a trial showed that nivolumab was more efficacious than everolimus,2 and nivolumab rapidly became a standard of care as second-line therapy, after failure of first-line VEGF inhibitors. In 2018, the combination of two immune checkpoint inhibitors, nivolumab and ipilimumab, were shown to have better efficacy than sunitinib.3 This combination, which was approved recently by the Food and Drug Administration and the European Medicines Agency, is the new standard of care, primarily in intermediate- and poor-risk patients.
New England Journal of Medicine , éditorial en libre accès, 2018