Developing an Ideal Risk Stratification Model for Metastatic Renal Cell Carcinoma
Menée à partir de données portant sur 1 220 patients atteints d'un carcinome métastatique à cellules rénales traité par atézolizumab (plus bévacizumab) ou sunitinib, cette étude évalue l'intérêt du "modified Glasgow prognostic score", basé sur la protéine C réactive et l'albumine, pour prédire la réponse thérapeutique
Over the past decade, significant strides have been made in treating metastatic renal cell carcinoma (mRCC). The introduction of immune-checkpoint inhibitor (ICI)-based treatment regimens for treating mRCC has significantly improved survival outcomes compared with sunitinib, a vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI). These regimens include the combination of ICI with either another ICI or a VEGF-TKI, such as nivolumab plus ipilimumab, nivolumab plus cabozantinib, pembrolizumab plus axitinib, pembrolizumab plus lenvatinib, and nivolumab plus axitinib. The median overall survival (OS) of patients with mRCC currently stands at approximately 55 months, a dramatic improvement from approximately 18 months just a decade ago. As a next step in clinical development, triplet therapy is now being explored in advanced disease. The recently reported phase 3 COSMIC-313 clinical trial showed improved efficacy of triplet therapy regimen comprising nivolumab, ipilimumab, and cabozantinib over the combination of nivolumab plus ipilimumab. However, to date, there has not been evidence to support treatment escalation or deescalation based on either imaging or biomarker-based response after initiating therapy. In this context, the PDIGREE study (NCT03793166) investigated an imaging response-based treatment strategy after beginning treatment with nivolumab plus ipilimumab. Patients with mRCC who experienced complete response or progressive disease at 3-month imaging assessment were assigned to receive nivolumab maintenance and cabozantinib, respectively. Patients who experience neither complete response nor progressive disease (ie, those with stable disease and partial response) were randomized to either continuation of nivolumab monotherapy or the addition of cabozantinib to nivolumab. However, patients with stable disease results on imaging scans may not represent a homogeneous group of patients and have variable survival outcomes. Thus, developing a reliable on-treatment prognostic or predictive biomarker may refine these imaging-based response-adapted treatment escalation or deescalation strategies.
JAMA Oncology , éditorial, 2022