Risk classification and nivolumab plus ipilimumab combination therapy for treatment of renal cell carcinoma

The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) classification is often used to predict the prognosis of patients treated with molecularly targeted agents. In this review, the authors describe the prognostic value of the neutrophil-lymphocyte ratio and C-reactive protein for Japanese patients with renal cell carcinoma. Both markers may help identify which patients are likely to have a poor prognosis despite molecularly targeted therapy. In these circumstances, the CheckMate 214 trial showed that nivolumab plus ipilimumab combination therapy was superior to sunitinib for the treatment of patients with intermediate/poor prognosis. As a consequence, the combination of nivolumab plus ipilimumab is now positioned as standard first-line treatment for renal cell carcinoma, and the IMDC classification is recommended as an aid in treatment decisions. Although careful management of immune-related adverse events is necessary, nivolumab plus ipilimumab combination therapy is expected to improve the outcomes of renal cell carcinoma for which the prognosis is otherwise generally poor.