4.1 Review

Renal cell carcinoma pathology in 2021: 'new need for renal cancer immune profiling'

Journal

CURRENT OPINION IN UROLOGY
Volume 31, Issue 3, Pages 228-235

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOU.0000000000000864

Keywords

immunotherapy; metastatic disease; molecular profiling; renal cell carcinoma; tumor microenvironment

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Recent guidelines have highlighted immune checkpoint inhibition as a core treatment strategy in advanced clear cell RCC, but the unsatisfactory prognosis of many patients may be due to resistance mechanisms within the tumor immune microenvironment. The complexity of the RCC TIME and its potential interdependence with tumor intrinsic alterations has been newly recognized, suggesting the importance of further investigation in metastatic RCC.
Purpose of review The aim of this review is to outline characteristics of the renal cell carcinoma (RCC) tumor immune microenvironment (TIME), the potential impact of tumor intrinsic alterations on the TIME and the value of metastatic tissue assessment in this context. Recent findings According to the latest European Association of Urology, European Society for Medical Oncology and National Comprehensive Cancer Network guidelines immune checkpoint inhibition represents a new core treatment strategy in advanced clear cell RCC (ccRCC). Despite its success, the prognosis of many RCC patients remains unsatisfactory most likely because of resistance mechanisms within the TIME. Moreover, most studies assess the primary tumor even though the advanced metastatic disease is targeted. Overall, metastatic RCC has hardly been investigated. First insights into the complexity of the genomic and immune landscape in RCC were recently provided. The functional impact of tumor intrinsic alterations on the TIME has just been described potentially contributing to therapy response in RCC. The complexity of the RCC TIME and its potential interdependence with tumor intrinsic alterations has only just been recognized. A deeper understanding of the TIME may reveal predictive and prognostic biomarkers long-awaited in RCC, improve RCC patient stratification and could possibly be most instructive if assessed in metastatic tissue.

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