Adjuvant therapy for renal cell carcinoma in 2023: hopes and disappointments

Purpose It is known that 30% of clear cell renal cell carcinomas (ccRCC) will develop progressive disease after surgical treatment. These patients with high-risk ccRCC require adjuvant therapy after nephrectomy or resection of metastases. The article presents an overview of the results of recent stu...

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Bibliographic Details
Published in:World journal of urology 2023-07, Vol.41 (7), p.1855-1859
Main Authors: Tsimafeyeu, Ilya, Basin, Michael F., Bratslavsky, Gennady
Format: Article
Language:English
Subjects:
Adjuvant therapy
Carcinoma, Renal Cell - drug therapy
Carcinoma, Renal Cell - pathology
Clear cell-type renal cell carcinoma
Clinical trials
Combined Modality Therapy
Humans
Immune checkpoint inhibitors
Kidney cancer
Kidney Neoplasms - drug therapy
Kidney Neoplasms - pathology
Medicine
Medicine & Public Health
Metastases
Metastasis
Neoplasm Recurrence, Local
Nephrectomy
Nephrology
Nivolumab - therapeutic use
Oncology
Original Article
Pembrolizumab
Randomized Controlled Trials as Topic
Urology
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Summary:Purpose It is known that 30% of clear cell renal cell carcinomas (ccRCC) will develop progressive disease after surgical treatment. These patients with high-risk ccRCC require adjuvant therapy after nephrectomy or resection of metastases. The article presents an overview of the results of recent studies in adjuvant therapy. Methods We analyzed the results of randomized trials of targeted therapy and checkpoint inhibitors in high-risk ccRCC patients. Results Targeted therapy did not significantly reduce this risk or/and did not affect overall survival. Three randomized studies investigating nivolumab, ipilimumab, and atezolizumab in the adjuvant setting also failed without improving disease-free survival. Pembrolizumab had a significant impact on the disease-free survival in the entire population, with the greatest effect in patients after metastasectomy, but mature overall survival data are not yet available. Conclusions In conclusion, it must be noted that, at present, it has not been possible to achieve magnificent success in adjuvant therapy of RCC in patients at high risk of relapse after surgical treatment. There remains hope for adjuvant pembrolizumab, which has been used for high-risk population including patients with removed metastases who may benefit more from therapy.
ISSN:1433-8726
0724-4983
1433-8726
DOI:10.1007/s00345-023-04450-8