Management of Immune-Related Adverse Events from Immune-Checkpoint Inhibitors in Advanced or Metastatic Renal Cell Carcinoma

Simple Summary Today, most patients with metastatic renal cancer receive systemic treatment with so-called immune-checkpoint inhibitors that shall activate a patient's immune system. For patients without prior therapy, these therapeutic agents are combined with a second immunotherapeutic drug or with a therapeutic agent intended to reduce the tumour's blood supply, namely tyrosine kinase inhibitors directed against the vascular endothelial growth factor receptor (VEGFR-TKI). Both parts of the combination therapy cause side effects that need to be treated and handled differently depending on the therapeutic agent responsible for the complaints. Therefore, it is of crucial importance to recognize the side effects and relate them to the right therapeutic agent. Within this review we describe the most frequent immune-related side effects of immune-checkpoint inhibitors, especially focusing on their distinction from side effects caused by VEGFR-TKI. Additionally, we explain the management of these complaints as well as their impact on the therapy. Immune checkpoint inhibitors (ICI) are now, among other cancers, routinely used for the treatment of advanced or metastatic renal cell carcinoma (mRCC). In mRCC various combinations of ICIs and inhibitors of the vascular epidermal growth factor receptor tyrosine kinase (VEGFR-TKIs) as well as dual checkpoint inhibition (nivolumab + ipilimumab), the latter for patients with intermediate and poor risk according to IMDC only (international metastatic renal cell carcinoma database consortium), are now standard of care in the first line setting. Therefore, a profound understanding of immune-related adverse events (irAE) and the differential diagnosis of adverse reactions caused by other therapeutic agents in combination therapies is of paramount importance. Here we describe prevention, early diagnosis and clinical management of the most relevant irAE derived from ICI treatment focusing on the new VEGFR-TKI/ICI combinations.