Vol 27, No 6 (2022)
Letter to the Editor
Published online: 2022-11-02

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Immune combinations and complete response: a new hope for metastatic renal cell carcinoma

Martina Catalano1, Gabriella Nesi1, Giandomenico Roviello1
Rep Pract Oncol Radiother 2022;27(6):1123-1124.



Letter to the editor

Reports of Practical Oncology and Radiotherapy

2022, Volume 27, Number 6, pages: 1123–1124

DOI: 10.5603/RPOR.a2022.0119

Submitted: 22.08.2022

Accepted: 27.10.2022

© 2022 Greater Poland Cancer Centre.

Published by Via Medica.

All rights reserved.

e-ISSN 2083–4640

ISSN 1507–1367

Immune combinations and complete response: a new hope for metastatic renal cell carcinoma

Martina CatalanoGabriella NesiGiandomenico Roviello
Department of Health Sciences, University of Florence, Florence, Italy

Address for correspondence: Giandomenico Roviello MD PhD, Department of Health Sciences, University of Florence, viale Pieraccini 6, 50139, Florence, Italy; e-mail: giandomenicoroviello@hotmail.it

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially

Key words: sunitinib; immunotherapy; angiogenesis; immune checkpoint inhibitors; tyrosine kinase inhibitors
Rep Pract Oncol Radiother 2022;27(6):–1124

According to Response Evaluation Criteria in Solid Tumours (RECIST), complete response is defined as “disappearance of all target lesions” [1]. Any pathological lymph nodes (whether target or non-target) must reduce to < 10 mm along the short axis. In all probability, patients who achieve complete response will have a better prognosis than those who do not.

Recently, several phase III studies have shown that immune combinations have greater efficacy than TKI monotherapy for primary treatment of metastatic renal cell carcinoma (mRCC) [2–7]. We performed a pooled analysis of pivotal phase III studies investigating immune combinations versus sunitinib administered to treatment-naïve mRCC patients, and compared the pooled risk of complete response of combination therapy with monotherapy. Pooled analysis with a fixed-effects model revealed that the incidence of complete response was higher in patients receiving immune combinations than in those treated with sunitinib alone [risk ratio (RR) = 2.41, 95% confidence interval (CI): 1.92–3.02; p 0.01 I2 = 81%; Fig. 1].

Figure 1. Forest plots of risk ratio (RR) for complete response comparing immune combinations with sunitinib

Significant limitations of our evaluation should be disclosed, namely meta-analysis based on literature data rather than on individual patient data, as well as substantial heterogeneity among experimental arm combinations. Nevertheless, our results point to higher complete response rates with immune combinations than with monotherapy, underlining the relevance of this approach in mRCC.

Conflict of interest

The other authors declare no conflict of interest.


No funding.

Ethical approval

Not necessary.


G.R. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: G.R., M.C. Acquisition of data: G.R. Analysis and interpretation of data: G.R. Drafting of the manuscript: G.R. Critical revision of the manuscript for important intellectual content: G.N. Statistical analysis: G.R. Supervision: G.N.


None declared.


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