Treatment of Advanced Renal Cell Carcinoma : Immunotherapies Have Demonstrated Overall Survival Benefits While Targeted Therapies Have Not

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Hemminki , O , Perlis , N , Bjorklund , J , Finelli , A , Zlotta , A R & Hemminki , A 2020 , ' Treatment of Advanced Renal Cell Carcinoma : Immunotherapies Have Demonstrated Overall Survival Benefits While Targeted Therapies Have Not ' , European urology open science , vol. 22 , pp. 61-73 . https://doi.org/10.1016/j.euros.2020.11.003

Title: Treatment of Advanced Renal Cell Carcinoma : Immunotherapies Have Demonstrated Overall Survival Benefits While Targeted Therapies Have Not
Author: Hemminki, Otto; Perlis, Nathan; Bjorklund, Johan; Finelli, Antonio; Zlotta, Alexandre R.; Hemminki, Akseli
Contributor: University of Helsinki, Research Programs Unit
University of Helsinki, Department of Oncology
Date: 2020-12
Language: eng
Number of pages: 13
Belongs to series: European urology open science
ISSN: 2666-1691
URI: http://hdl.handle.net/10138/324661
Abstract: Context: Current guidelines suggest several targeted therapies (TTs) and immunotherapies (ITs) in the treatment of advanced or metastatic renal cell carcinoma (mRCC). Ideal sequencing of these treatments is unclear. Objective: The primary objective was to evaluate the overall survival (OS) data of the treatments approved for mRCC. Secondary objectives included evaluating other signs of efficacy and adverse events. Evidence acquisition: We reviewed the current Food and Drug Administration-approved treatments for mRCC. Trials associated with approval were reviewed. We also included pre- and postapproval publications when appropriate. Evidence synthesis: There is minimal evidence supporting OS benefit for the nine approved TTs. They result in adverse events and are a considerable economic burden. For these reasons, their future role in mRCC treatment should be reevaluated, given the emergence of IT that have demonstrated OS benefits. Accumulating long-term survival data with high-dose interleukin-2 treatment suggests that this older treatment could still be considered for eligible patients. Checkpoint inhibitors have shown promising OS and durable responses; as such, the high cost of treatment might be justified. However, the available evidence does not suggest that adding TT to IT would increase efficacy over IT alone, but would add toxicity. Conclusions: Trial data supporting OS benefit are much stronger for ITs than for TTs. Combining checkpoint inhibitors with TTs has not been shown to produce better OS than checkpoint inhibitors alone, while more adverse events are present. Granting drug approvals based on efficacy without demonstrated OS benefit should be revisited. Patient summary: Approved treatments for metastatic kidney cancer include targeted and immune-based therapies. The former commonly produces temporary tumour shrinkage, but survival benefits are unclear. All approved immunotherapies have increased survival, and a proportion of patients appear cured. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.
Subject: Renal cell carcinoma
Kidney cancer
Advanced
Metastatic
Treatments
Approved
Review
Survival
Quality of life
Metastatic renal cell carcinoma
Advanced renal cell carcinoma
DOSE RECOMBINANT INTERLEUKIN-2
COST-EFFECTIVENESS ANALYSIS
BLIND PHASE-III
QUALITY-OF-LIFE
INTERFERON-ALPHA
OPEN-LABEL
1ST-LINE TREATMENT
SUNITINIB
EVEROLIMUS
SORAFENIB
3122 Cancers
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