Renal Carcinoma and Angiogenesis: Therapeutic Target and Biomarkers of Response in Current Therapies

SIMPLE SUMMARY: The treatment of renal cancer is currently based on the use of antiangiogenic drugs targeting the VEGF-A pathway and/or immunotherapy targeting immune checkpoint inhibitors. Despite combined therapies being approved as first-line treatments, all patients will not benefit from them. We highlight here the role of tumour angiogenesis in renal cancer which makes angiogenesis-related markers good candidates to predict response to treatments including immunotherapies. Less data is available in this field for recently combined treatments. A combination of angiogenesis-related biomarkers with markers of other processes would be relevant to progress in the aim of personalized treatment. ABSTRACT: Due to the aberrant hypervascularization and the high immune infiltration of renal tumours, current therapeutic regimens of renal cell carcinoma (RCC) target angiogenic or immunosuppressive pathways or both. Tumour angiogenesis plays an essential role in tumour growth and immunosuppression. Indeed, the aberrant vasculature promotes hypoxia and can also exert immunosuppressive functions. In addition, pro-angiogenic factors, including VEGF-A, have an immunosuppressive action on immune cells. Despite the progress of treatments in RCC, there are still non responders or acquired resistance. Currently, no biomarkers are used in clinical practice to guide the choice between the different available treatments. Considering the role of angiogenesis in RCC, angiogenesis-related markers are interesting candidates. They have been studied in the response to antiangiogenic drugs (AA) and show interest in predicting the response. They have been less studied in immunotherapy alone or combined with AA. In this review, we will discuss the role of angiogenesis in tumour growth and immune escape and the place of angiogenesis-targeted biomarkers to predict response to current therapies in RCC.