转移性肾细胞癌(mRCC)的治疗Sc\'enario已明显增加,从研究最多的分子靶向疗法到最近推出的疗法,免疫检查点抑制剂(ICIs)。基于ICI的分子靶向药物和ICI组合的最新临床试验表明,通过恢复对癌细胞的有效免疫反应和建立免疫记忆,不仅有可能获得更好的放射学应答,而且有可能获得更长的无进展生存期和总生存期.然而,酪氨酸激酶抑制剂(TKIs)的作用仍然至关重要,尤其是在患者中,对于临床特征,肿瘤负荷和合并症,在单一疗法中使用TKIs比与其他疗法联合使用有更大的益处。然而,以最好的方式使用这些新颖的选择,不仅需要大型临床试验的数据,还需要生物学机制的知识,分子途径,免疫学机制,以及与新的响应标准和终点相关的方法学问题。在这个复杂的场景中,我们回顾了最新临床试验的最新结果,为克服决策障碍提供指导,为日常临床实践中mRCC的管理提供切实可行的方法.此外,根据最近的文献,我们讨论了最具创新性的组合策略,这些策略将使我们获得最佳的临床治疗效果。
The therapeutic sc\"enario of metastatic renal cell cancer (mRCC) has noticeably increased, ranging from the most studied molecular target therapies to those most recently introduced, up to immune checkpoint inhibitors (ICIs). The most recent clinical trials with an ICI-based combination of molecular targeted agents and ICI show how, by restoring an efficient immune response against cancer cells and by establishing an immunological memory, it is possible to obtain not only a better radiological response but also a longer progression-free and overall survival. However, the role of tyrosine kinase inhibitors (TKIs) remains of fundamental importance, especially in patients who, for clinical characteristics, tumor burden and comorbidity, could have greater benefit from the use of TKIs in monotherapy rather than in combination with other therapies. However, to use these novel options in the best possible way, knowledge is required not only of the data from the large clinical trials but also of the biological mechanisms, molecular pathways, immunological mechanisms, and methodological issues related to both new response criteria and endpoints. In this complex scenario, we review the latest results of the latest clinical trials and provide guidance for overcoming the barriers to decision-making to offer a practical approach to the management of mRCC in daily clinical practice. Moreover, based on recent literature, we discuss the most innovative combination strategies that would allow us to achieve the best clinical therapeutic results.