Enrique Grande

How to Optimise Patients’ Care in the New Era of mRCC Treatment Landscape?


Immune checkpoint inhibitors (ICIs) have changed the way we combat mRCC. Combination therapy based on ICIs has demonstrated to be superior to the use of single agent tyrosine kinase inhibitors (TKIs).  Improvement in overall and progression free survival together with a better response rate has led to consider these novel combinations as the current reference upfront treatment for mRCC in daily practice. However, there many questions still to be answered in this field like how can we select in our clinic which is the best combination for each patient, what we should offer to those patients with non-clkear cell histologies, or does it worth to use a combination based on immunotherapy for the upfront treatment of patients with favorable-risk by IDMC classification? These are just few of the many questions that are still to be elucidated. Hopefully, we will be able to get a satisfactory response shortly due to the wide access that is expected and daily life data coming. Until that happens, we will need to keep on investigating on how we can find reliable biomarkers, what’s the role of cytoreductive nephrectomy, particularly the deferred one with these novel strategies, or look for a better outcome when using triplets. If we want to optimize the patients’ care in the new era of mRCC Treatment Landscape, we need to balance the expected activity with the expected toxicity of the combination we are thinking of but oriented to the patient we need to treat. Axspects like histology, tumor volume, comorbidities, comedications, access to drugs, patient’s preferences, etc… are taking more and more importance today.