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The adjuvant treatment of kidney cancer: a multidisciplinary outlook
Camillo Porta1,2, Laura Cosmai3, Bradley C Leibovich4
1Department of Internal Medicine, University of Pavia, Pavia, Italy. camillo.porta@icsmaugeri.it.
Abstract:
Approximately 70% of cases of kidney cancer are localized or locally advanced at diagnosis. Among patients who undergo surgery for these cancers, 30-35% will eventually develop potentially fatal metachronous distant metastases. Effective adjuvant treatments are urgently needed to reduce the risk of recurrence of kidney cancer and of dying of metastatic disease. To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit. Only two trials of an autologous renal tumour cell vaccine and of the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor sunitinib have shown positive results, but these have been criticized for methodological reasons and conflicting data, respectively. The results of two additional trials of targeted agents as adjuvant therapies have not yet been published. Novel immune checkpoint inhibitors are promising approaches to adjuvant therapy in kidney cancer, and a number of trials are now underway. An important component of the management of patients with kidney cancer, particularly those who undergo radical resection for localized renal cell carcinoma, is the preservation of kidney function to reduce morbidity and mortality. The optimal management of these patients therefore requires a multidisciplinary approach involving nephrologists, oncologists, urologists and pathologists.
Insights
Adjuvant treatments are needed for kidney cancer patients at high risk of recurrence. While some targeted therapies show promise, novel immune checkpoint inhibitors are a key focus for future adjuvant kidney cancer treatment strategies.
Area of Science:
- Oncology
- Nephrology
- Immunotherapy
Background:
- Approximately 70% of kidney cancer cases are diagnosed at localized or locally advanced stages.
- Despite surgery, 30-35% of patients develop fatal distant metastases, highlighting the need for effective adjuvant therapies.
- Current adjuvant treatments have largely failed, with limited positive results from specific vaccine and tyrosine kinase inhibitor trials facing scrutiny.
Purpose of the Study:
- To address the urgent need for effective adjuvant treatments to reduce kidney cancer recurrence and metastasis.
- To explore novel therapeutic strategies beyond existing options for localized and locally advanced kidney cancer.
- To emphasize the importance of multidisciplinary care in managing kidney cancer patients, focusing on kidney function preservation.
Main Methods:
- Review of existing clinical trial data for adjuvant therapies in kidney cancer.
- Evaluation of the efficacy and limitations of previously tested agents, including vaccines and sunitinib.
- Identification of promising novel approaches, particularly immune checkpoint inhibitors, currently under investigation.
Main Results:
- Most tested adjuvant agents have not demonstrated significant benefit in preventing kidney cancer recurrence or metastasis.
- Limited positive findings from autologous renal tumour cell vaccine and sunitinib trials require further validation due to methodological concerns.
- Ongoing trials are exploring targeted agents and immune checkpoint inhibitors as potential adjuvant therapies.
Conclusions:
- There is a critical unmet need for effective adjuvant treatments to improve outcomes for kidney cancer patients at risk of recurrence.
- Novel immune checkpoint inhibitors represent a promising avenue for future adjuvant therapy in kidney cancer.
- Optimal management necessitates a multidisciplinary approach, integrating specialists to preserve kidney function and improve patient survival.
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