Combined blockade of vascular endothelial growth factor and programmed death 1 pathways in advanced kidney cancer

Clin Adv Hematol Oncol. 2017 Jun;15(6):478-488.

Abstract

Targeted and immune-based therapies have improved outcomes in advanced kidney cancer, yet novel strategies are needed to extend the duration of these benefits and expand them to more patients. Combined inhibition of vascular endothelial growth factor (VEGF) and the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) pathways with therapeutic agents already in clinical use may offer such a strategy. Here, we describe the development and clinical evaluation of VEGF inhibitors and, separately, PD-1/PD-L1 inhibitors. We present preclinical evidence of interaction between these pathways and the rationale for combined blockade. Beyond well-known effects on pathologic angiogenesis, VEGF blockade also may decrease immune tolerance and enhance PD-1/PD-L1 blockade. We conclude with the results of several early trials of combined VEGF and PD-1/PD-L1 blockade, which demonstrate encouraging antitumor activity, and we pose questions for future study.

Publication types

  • Review

MeSH terms

  • Animals
  • Antineoplastic Agents, Immunological / therapeutic use*
  • B7-H1 Antigen / antagonists & inhibitors
  • B7-H1 Antigen / immunology
  • Humans
  • Immunotherapy / methods*
  • Kidney / drug effects
  • Kidney / immunology
  • Kidney / pathology
  • Kidney Neoplasms / drug therapy
  • Kidney Neoplasms / immunology
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / therapy*
  • Neovascularization, Pathologic / drug therapy
  • Neovascularization, Pathologic / immunology
  • Neovascularization, Pathologic / pathology
  • Neovascularization, Pathologic / therapy
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors*
  • Programmed Cell Death 1 Receptor / immunology
  • Signal Transduction / drug effects
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Vascular Endothelial Growth Factor A / immunology

Substances

  • Antineoplastic Agents, Immunological
  • B7-H1 Antigen
  • Programmed Cell Death 1 Receptor
  • Vascular Endothelial Growth Factor A