Renal Cell Carcinoma Treatment & Management: Approach Considerations, Surgical Treatment, Molecular-Targeted Agents

Cancer research · Renal cell carcinoma

The combination of pembrolizumab plus lenvatinib or pembrolizumab plus axitinib is preferred first‑line systemic therapy for metastatic renal cell carcinoma, providing superior progression‑free survival compared with the VEGF‑directed tyrosine kinase inhibitor sunitinib.

This post‑hoc analysis of the Meet‑URO 15 study evaluated the effect of bone‑targeting agents (BTAs) – denosumab and zoledronic acid – on progression‑free survival (PFS) and overall survival (OS) among 203 patients with metastatic renal cell carcinoma (mRCC) and bone metastases receiving nivolumab. Patients in the BTA group (n = 38) had a median PFS of 291 days versus 117 days in the non‑BTA group (p = 0.005) and a median OS of 960 days versus 397 days (p = 0.008). Inverse probability of treatment weighting confirmed these survival benefits, with a reduced risk of death (HR = 0.55) and progression or death (HR = 0.58) for BTA users. Among BTAs, denosumab yielded superior OS (1,662 days vs. 681 days vs. 411 days for BTA vs. ZA vs. non‑BTA, p < 0.001) and PFS (1,101 days vs. 242 days vs. 132 days, p < 0.001). These data suggest a potential benefit of BTAs, especially denosumab, in mRCC patients with bone metastases treated with nivolumab.

Effective first‑line therapy improves survival and quality of life for patients with stage IV RCC, a disease for which no curative option exists and survival has historically been limited.

Evidence level: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.

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