Abstract
The incidence of renal cell carcinoma (RCC) in the Czech Republic is among the highest worldwide. In the treatment of metastatic RCC (mRCC), even methods of local therapy can be considered individually; however, systemic cancer therapy has a dominant role and has recently made significant advances.
Targeted therapy and immunotherapy consisting in the inhibition of PD1 (programmed cell death protein 1) receptor and its ligand (PD-L1) or in CTLA4 (cytotoxic T-lymphocyte antigen 4) inhibition have reached the greatest importance. In the case of mRCC, similar to other cancer diseases, the choice of first-line treatment is of major importance.
The current trend is administration of combination therapy. This can involve combined targeted therapy and immunotherapy and/or the administration of combination immunotherapy.
The choice of optimal therapeutic strategy is complicated by the fact that, as yet, there are no clearly defined prognostic or predictive biomarkers utilizable in routine clinical practice. On the basis of clinical findings and laboratory results, it is necessary to stratify patients with mRCC into prognostic groups prior to initiation of systemic treatment.
One of the options is the combination of the tyrosine kinase receptor inhibitor (TKI) axitinib with the anti-PD-L1 antibody avelumab. The phase 3 JAVELIN Renal 101 clinical trial evaluated the benefit of combination therapy with avelumab plus axitinib in comparison with a standard treatment with first-line sunitinib for mRCC with a clear cell component in 886 patients.
The trial has shown a significant improvement in the progression-free survival (PFS) in patients treated with the avelumab plus axitinib combination, both in the overall population and in that with PD-L1 expression. The overall survival (OS) has not yet been extended, also due to data immaturity.
Currently in the Czech Republic, the avelumab plus axitinib combination can be administered in patients with mRCC in the first line in the good prognosis group.