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Abstract
Approximately 70% of cases of kidney cancer are localized or locally advanced at diagnosis. Among patients who undergo surgery for these cancers, 30-35% will eventually develop potentially fatal metachronous distant metastases. Effective adjuvant treatments are urgently needed to reduce the risk of recurrence of kidney cancer and of dying of metastatic disease. To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit. Only two trials of an autologous renal tumour cell vaccine and of the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor sunitinib have shown positive results, but these have been criticized for methodological reasons and conflicting data, respectively. The results of two additional trials of targeted agents as adjuvant therapies have not yet been published. Novel immune checkpoint inhibitors are promising approaches to adjuvant therapy in kidney cancer, and a number of trials are now underway. An important component of the management of patients with kidney cancer, particularly those who undergo radical resection for localized renal cell carcinoma, is the preservation of kidney function to reduce morbidity and mortality. The optimal management of these patients therefore requires a multidisciplinary approach involving nephrologists, oncologists, urologists and pathologists.
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Leaman Alcibar O, Candini D, López-Campos F, Albert Antequera M, Morillo Macías V, Conde AJ, Rodríguez Pérez A, Hervás Morón A, Contreras Martínez J, Ferrer Albiach C, Navarro Aguilar S, Rodríguez-Ruiz ME. Time for radioimmunotherapy: an overview to bring improvements in clinical practice. Clin Transl Oncol 2019; 21:992-1004. [PMID: 30644044 DOI: 10.1007/s12094-018-02027-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/21/2018] [Indexed: 12/27/2022]
Abstract
Harnessing the patient's own immune system against an established cancer has proven to be a successful strategy. Within the last years, several antibodies blocking critical "checkpoints" that control the activation of T cells, the immune cells able to kill cancer cells, have been approved for the use in patients with different tumours. Unfortunately, these cases remain a minority. Over the last years, radiotherapy has been reported as a means to turn a patient's own tumour into an in situ vaccine and generate anti-tumour T cells in patients who lack sufficient anti-tumour immunity. Indeed, review data show that the strategy of blocking multiple selected immune inhibitory targets in combination with radiotherapy has the potential to unleash powerful anti-tumour responses and improve the outcome of metastatic solid tumours. Here, we review the principal tumours where research in this field has led to new knowledge and where radioimmunotherapy becomes a reality.
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Affiliation(s)
- O Leaman Alcibar
- Radiation Oncology Department, Central University Hospital of Defence Gómez Ulla, Madrid, Spain.
| | - D Candini
- Radiation Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - F López-Campos
- Radiation Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - M Albert Antequera
- Radiation Oncology Department, La Ribera University Hospital, Valencia, Spain
| | - V Morillo Macías
- Radiation Oncology Department, General Hospital in Castellón de la Plana, Castellón, Spain
| | - A J Conde
- Radiation Oncology Department, The University and Polytechnic La Fe Hospital, Valencia, Spain
| | - A Rodríguez Pérez
- Radiation Oncology Department, Internacional Ruber Hospital, Madrid, Spain
| | - A Hervás Morón
- Radiation Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - C Ferrer Albiach
- Radiation Oncology Department, General Hospital in Castellón de la Plana, Castellón, Spain
| | - S Navarro Aguilar
- Radiation Oncology Department, Oncology and Radiotherapy Institut, Ricardo Palma Clinic, Lima, Peru
| | - M E Rodríguez-Ruiz
- Radiation Oncology Department, University of Navarra Clinic and CIMA, Navarra, Spain
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Buttigliero C, Allis S, Tucci M, Zichi C, Leone G, Di Stefano RF, Ruo Redda MG, Ricardi U, Scagliotti GV, Di Maio M, Filippi AR. Role of radiotherapy in improving activity of immune-modulating drugs in advanced renal cancer: Biological rationale and clinical evidences. Cancer Treat Rev 2018; 69:215-223. [PMID: 30096699 DOI: 10.1016/j.ctrv.2018.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Abstract
In the last few years, immune checkpoint inhibitors have been extensively investigated in renal cell carcinoma and led to remarkable results. Radiation therapy may increase the activity of immune modulating agents through different mechanisms, priming the immune system, recruiting immune cells to the tumor environment, and altering the immunosuppressive effects of the tumor microenvironment. Preclinical studies reported increased loco-regional control when radiation is combined with immune-checkpoint blockade. Moreover, increased systemic disease control has been demonstrated when local radiation is combined with both anti-CTLA-4 and anti-PD-1/PD-L1 inhibitors. Actually, several trials are ongoing testing the activity of radiation therapy in combination with different immune-modulating agents for the treatment of metastatic renal cell carcinoma. The aim of this paper is to focus on the biological rationale of adding radiation therapy to immune-modulating agents in renal cell carcinoma and to review the currently available clinical evidence about the combination of radiotherapy and immunotherapy.
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Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Simona Allis
- Radiation Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Clizia Zichi
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Gianmarco Leone
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Rosario Francesco Di Stefano
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Maria Grazia Ruo Redda
- Radiation Oncology, Ordine Mauriziano Hospital, Department of Oncology, University of Turin, Via Magellano 1, 10028 Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology, Città della Salute e della Scienza di Torino, Department of Oncology, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Giorgio Vittorio Scagliotti
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Ordine Mauriziano Hospital, Department of Oncology, University of Turin, Via Magellano 1, 10028 Turin, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Stanisic S, Cicchetti A, Porta C, Procopio G, Berto P. Costo-Efficacia di cabozantinib nel trattamento di seconda linea del tumore a cellule renali metastatico (mRCC) in Italia. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318790734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Americo Cicchetti
- Facoltà di Economia dell’Università Cattolica del Sacro Cuore, Roma, Italia
| | - Camillo Porta
- Università degli Studi di Pavia e IRCCS Policlinico San Matteo di Pavia, Pavia, Italia
| | - Giuseppe Procopio
- Oncologia medica genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italia
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