Abstract：
Renal cell carcinoma (RCC) is the most common kidney cancer in adults (approximately 90%), and clear cell RCC (ccRCC) is the most frequent histologic subtype (approximately 75%). We reviewed the safety and efficacy of checkpoint inhibitors (CPIs) in ccRCC, identifying 5927 articles in PubMed, Embase, Cochrane, and Web of Science. Ten randomized control (N = 7765) and 10 non-randomized (N = 572) studies were included. Overall, 4819 patients treated with CPI combinations were compared with everolimus, sunitinib, or placebo. Overall response rates (ORR) were 9-25% with nivolumab (niv), 42% with niv + ipilimumab (ipi), 55.7% with niv + cabozantinib, 56% with niv + tivozanib vs. 5% with everolimus. ORR was 51.5-58% with avelumab + axitinib vs. 25.5% with sunitinib. ORR was 59.3-73% with pembrolizumab + tyrosine kinase inhibitor vs. 25.7% with sunitinib. ORR was 32-36% with atezolizumab + bevacizumab vs. 29-33% with sunitinib. In patients with PD-L1+ve and -ve ccRCC, niv, atezolizumab, ipi, and pembrolizumab were safe and effective alone and when combined with cabozantinib, tivozanib, axitinib, levantinib, and pegilodecakin. Atezolizumab + bevacizumab was safe and effective in ccRCC with high PD-L1 expression. Pembrolizumab was safe and effective in preventing recurrence in ccRCC patients with nephrectomy. Additional randomized, double-blind, multicenter clinical trials are needed to confirm these results.
摘要：
肾细胞癌（RCC）是成人中最常见的肾癌（约90％），透明细胞RCC（ccRCC）是最常见的组织学亚型（约75％）。我们回顾了检查点抑制剂（CPIs）在ccRCC中的安全性和有效性，在PubMed中识别5927篇文章，Embase,科克伦,和WebofScience。包括10项随机对照研究（N=7765）和10项非随机研究（N=572）。总的来说,使用CPI组合治疗的4819例患者与依维莫司进行了比较，舒尼替尼,或安慰剂。nivolumab（niv）的总有效率（ORR）为9-25%，42%使用niv+ipilimumab(ipi)，55.7%使用niv+cabozantinib，56%与niv+tivozanib对比5%与依维莫司。阿维鲁单抗+阿西替尼的ORR为51.5-58%，与25.5%与舒尼替尼。Pembrolizumab+酪氨酸激酶抑制剂的ORR为59.3-73％25.7%与舒尼替尼。阿替珠单抗+贝伐单抗的ORR为32-36%29-33%与舒尼替尼。在PD-L1+ve和-veccRCC患者中，尼夫,阿替珠单抗,ipi,和派博利珠单抗单独使用以及与卡博替尼联合使用时安全有效，tivozanib,阿西替尼,levantinib,还有pegilodecakin.阿替珠单抗+贝伐单抗在PD-L1高表达的ccRCC中是安全有效的。Pembrolizumab可安全有效地预防ccRCC患者肾切除术后的复发。额外的随机化，双盲,需要多中心临床试验来证实这些结果.
