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Introduction: The combination of immunotherapy and targeted therapy is currently marking a new era in the treatment of renal cancer. The latest clinical guidelines recommend the use of drug combinations for the first-line treatment of advanced renal cancer. The aim of this review is to compare the efficacy of combined cabozantinib + nivolumab therapy with other immune checkpoint inhibitors combined with tyrosine kinase inhibitors or monoclonal antibodies blocking the CTLA-4 (cytotoxic T cell antigen 4) in the first-line treatment of metastatic clear-cell renal cell carcinoma (RCC). Methodology: A systematic literature search was carried out in the PubMed and EMBASE databases. Randomized controlled trials (RCTs) on therapies recommended by the latest EAU and ESMO guidelines for treatment-naïve metastatic RCC (i.e., lenvatinib + pembrolizumab, axitinib + pembrolizumab and nivolumab + ipilimumab) were searched. A network meta-analysis (NMA) was performed for data synthesis. The methodology of included RCTs was assessed using the Cochrane RoB two tool. The data were analyzed in the overall population as well as in risk subgroups defined according to the International Metastatic Database Consortium (IMDC) i.e., patients with a favorable and intermediate or poor prognoses. The most recent cut-off dates from included studies were analyzed. Results: Four RCTs (CheckMate 9 ER, KEYNOTE-426, CLEAR and CheckMate 214) were included in the review. No studies directly comparing cabozantinib + nivolumab with any of the drug combinations included in this review were available. NMA showed that cabozantinib + nivolumab was superior compared to axitinib + pembrolizumab and nivolumab + ipilimumab in all analyzed comparisons (overall population and IMDC risk subgroups), both in terms of overall survival and progression-free survival (PFS). The advantage of cabozantinib + nivolumab was statistically significant only for PFS when compared to nivolumab + ipilimumab in the overall population. The results for the comparison of cabozantinib + nivolumab with lenvatinib + pembrolizumab showed numerical superiority of lenvatinib + pembrolizumab combination in terms of overall survival, but none of the results were statistically significant. The advantage of lenvatinib + pembrolizumab over cabozantinib + nivolumab in terms of PFS was statistically significant in the overall and favorable prognosis population. Conclusion: Inclusion of the most recent cut-off data from CheckMate 9 ER did not affect the role of the cabozantinib + nivolumab combination for treatment-naïve metastatic RCC. Cabozantinib + nivolumab is an effective therapeutic option for the first-line treatment of advanced renal cancer that is recommended both in the latest European and American guidelines for all IMDC risk groups.
RESUMO
BACKGROUND: Late infantile neuronal ceroid lipofuscinosis (LINCL) is the most common childhood progressive encephalopathy. Severe psychodegradation with diminish of cognitive functions together with ataxia, myoclonus, resistant epilepsy, paresis and blindness in aged 3-6 yrs are observed. THE AIM OF STUDY: Cognition of psychomotor development in children with LINCL. MATERIAL AND METHODS: In group of 65 children with LINCL diagnosed by ultrastructural conjunctive examinations and/or low activity of TPP1 enzyme in leukocytes, the psychological assessment during 3 years of disease was performed. 25 children had done psychological test with use Psyche Cattell Scale for Small Children twice in 1-3 years intervals. In next 40 children clinical, neurological observations during some years was made. RESULTS: In 25 children Psyche Cattell tests revealed severe mental retardation (IQ 20-35) in 16% and profound mental retardation in 84%. In the first year of disease 56% of children was degraded to the profound mental retardation (44% in moderate and 12% in severe mental retardation). In all 65 affected children already in the first neurological visit the delay and regress in global of mental development was observed (any of children hadn't have IQ rates on average level). Analysis of psychodegradation rate revealed in 60% of children after 1-3 years from onset of disease very rapid mental retardation and decreased IQ above 2 SD and in 24% above 3SD. CONCLUSIONS: Common progressive encephalopathy LINCL caused very rapid severe mental degradation, already at the first stage of the development of disease and that is very important diagnostic sign.