Complete response and renal cell carcinoma in the immunotherapy era: The paradox of good news. (September 2021) - Zambrana, Francisco
Highlights: ICI-combinations provide the chance to obtain sustained long-term outcomes and CRs in a subgroup of patients. CR could emerge as a surrogate for survival. Durable benefit is not limited to patients with CR, but also those achieving major response. Best timing for immunotherapy discontinuation in CR is still in debate. Abstract: Immune-checkpoint inhibitor-based therapy has revolutionized the natural history of metastatic renal cell carcinoma (mRCC) providing better survival outcomes, higher rates of complete responses (CR) and durable remissions. Along with these advances, new challenges have emerged. RECIST and new immune-response criteria may be equivocal identifying complete responses. How to define a durable response and what is the optimal treatment duration remains unclear. Furthermore, the real value of a complete and deep response, whether or not it can be considered curation and whether or not immunotherapy discontinuation should be considered after complete response, are questions that remain open. The present article reviews the current evidence regarding the impact and challenges of managing complete and durable responses in mRCC treated with immune-checkpoint inhibitors.