Settembre Ottobre 2021

Immunotherapy in kidney cancer: how it has changed and what are the challenges for the nephrologist – focus on pembrolizumab

Abstract

Kidney cancer accounts for about 3.5% of all malignant neoplasms; in 85% of cases the tumor arises from cells of the renal parenchyma, with an incidence of 70% of the clear cells subtype.

Surgery, at present, is the treatment of choice for most renal cancers; medical therapy, on the other hand, has only palliative purposes and is used only in the relapsed or metastatic patients.

The therapeutic toolbox available in the fight against renal cancer is continuously renewed due to the approval of new drugs. In particular, in the 2000s, antiangiogenic drugs were introduced and showed good efficacy in terms of increased survival in patients with advanced renal carcinoma.

Immunotherapy was a treatment strategy for renal cancer in the 1980s, when cytokines such as Interleukin-2 and Interferon were administered. The advent of antiangiogenic drugs had bound immunotherapy to a secondary role until the discovery of immune check-point inhibitors (ICIs), which have been approved in the various lines of treatment, in monotherapy or in combination with other drugs, as they have shown to increase the oncological outcome.

In this review we analyze the evolution of immunotherapy for the treatment of kidney tumor from the viewpoint of nephrologists, with a special focus on renal adverse events, pembrolizumab and its recent approval as first line therapy in association with axitinib.

Keywords: immunotherapy, kidney cancer, interstitial nephritis, acute kidney injury, molecularly targeted agents.

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Epidemiologia del carcinoma renale

Il tumore del rene rappresenta circa il 3.5% di tutte le neoplasie maligne (4.6% tra gli uomini e 3% tra le donne) e, in Italia, si colloca al decimo posto come frequenza. Nell’85% delle diagnosi di tumore del rene la neoplasia è a partenza da cellule del parenchima renale e tra queste si riscontra un sottotipo a cellule chiare nel 70% dei casi [1,2].

Il tumore del rene è tipicamente una neoplasia delle nazioni industrializzate dell’emisfero nord; per quanto riguarda l’Italia, la sua incidenza è maggiore nelle regioni del nord e del centro, minore al sud e nelle isole [3].

L’incidenza è nettamente superiore nel sesso maschile rispetto a quello femminile: 1 su 38 uomini e 1 su 90 donne hanno una probabilità teorica di sviluppare questo tumore nel corso della loro vita. L’incidenza aumenta parallelamente all’età con un picco nella sesta decade e circa l’80% delle diagnosi avviene in pazienti con età compresa tra i 40 e i 69 anni [1].

 

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