Checkpoints inhibitors in Metastatic Papillary Renal Cell Carcinoma
Menée à partir de données d'études rétrospectives et prospectives, cette étude analyse l'intérêt des inhibiteurs de points de contrôle immunitaire pour traiter les patients atteints d'un carcinome papillaire à cellules rénales de stade métastatique
Papillary Renal Cell Carcinoma (pRCC) is the most common non-clear cell RCC (nccRCC)and a distinct entity, although heterogenous, associated with poor outcomes. The treatmentlandscape of metastatic pRCC (mpRCC) relied so far on targeted therapies, mimickingprevious developments in metastatic clear-cell renal cell carcinoma. However, antiangiogenicsas well as mTOR inhibitors retain only limited activity in mpRCC. As development ofimmune checkpoint inhibitors (ICI) is now underway in patients with mpRCC, we aimedat discussing early activity data and potential for future therapeutic strategiesin monotherapy or combination. Expression of immune checkpoints such as PD-L1 andinfiltrative immune cells in pRCC could provide insights into their potential immunogenicity,although this is currently poorly described. Based on retrospective and prospectivedata, efficacy of ICI as single agent remains limited. Combinations with tyrosine-kinaseinhibitors, notably with anti-MET inhibitors, harbor promising response rates andmay enter the standard of care in untreated patients. Collaborative work is neededto refine the molecular and immune landscape of pRCC, and pursue efforts to set uppredictive biomarker-driven clinical trials in these rare tumors.