IO Plus TKI Shows No Survival Gain in Favourable-Risk RCC
This narrative review challenges reflexive use of immunotherapy plus tyrosine kinase inhibitor combinations in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) favourable-risk metastatic clear cell renal cell carcinoma, arguing that de-escalation is often defensible.
Combination therapy may not benefit favourable-risk metastatic renal cell carcinoma patients.
Combination therapy of immune checkpoint inhibitors and vascular endothelial growth factor tyrosine kinase inhibitors is commonly used for metastatic renal cell carcinoma, but their benefit in favourable-risk patients is unclear. A pooled analysis of four phase III trials demonstrated no overall survival benefit of immune checkpoint inhibitor plus vascular endothelial growth factor tyrosine kinase inhibitor over sunitinib monotherapy in favourable-risk patients (hazard ratio 1.24; 95% CI 0.86 to 1.78). Despite improved response rates with combination therapy, substantial toxicity and higher costs make monotherapy and active surveillance valid choices for selected favourable-risk patients. For favourable-risk patients, carefully consider monotherapy or surveillance instead of uncritical combination therapy.
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