Adjuvant therapy for high-risk renal cell carcinoma after nephrectomy how many trials are positive? Only one or more

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A Ravaud1

  • 1Department of Medical Oncology, Bordeaux University Hospital, Hôpital Saint-André, 1 rue Jean Burguet, Bordeaux, 33075 cedex, France.

Asia-Pacific Journal of Clinical Oncology
|August 28, 2020
PubMed

Insights

Adjuvant anti-angiogenic therapy for renal cell carcinoma (RCC) after nephrectomy showed mixed results. Only S-TRAC demonstrated a significant benefit in disease-free survival (DFS) with sunitinib, suggesting potential for high-risk patients.

Area of Science:

  • Oncology
  • Nephrology
  • Pharmacology

Background:

  • Adjuvant therapy for renal cell carcinoma (RCC) post-nephrectomy aims to improve outcomes.
  • Vascular Endothelial Growth Factor (VEGF) tyrosine kinase inhibitors (TKIs) are a class of targeted therapies explored in this setting.

Purpose of the Study:

  • To review and synthesize findings from key clinical trials investigating adjuvant VEGFR TKI therapy in renal cell carcinoma.
  • To assess the efficacy and trends of anti-angiogenic therapy in patients with high-risk RCC following nephrectomy.

Main Methods:

  • Analysis of four major clinical trials: S-TRAC, ASSURE, PROTECT, and ATLAS.
  • Comparison of outcomes, specifically disease-free survival (DFS), between VEGFR TKI treatment arms and placebo/control arms.

Main Results:

  • The S-TRAC trial showed a statistically significant improvement in DFS with sunitinib compared to placebo.
  • The ASSURE, PROTECT, and ATLAS trials did not demonstrate significant DFS gains with sunitinib, sorafenib, pazopanib, or axitinib, respectively.
  • A potential trend suggests a possible benefit of anti-angiogenic therapy in high-risk RCC patients.

Conclusions:

  • Adjuvant VEGFR TKI therapy in RCC post-nephrectomy yields inconsistent results across major trials.
  • While only S-TRAC met its primary endpoint, a trend for benefit in high-risk patients warrants further discussion.
  • Shared decision-making with patients regarding adjuvant treatment should consider these nuanced findings.
Keywords:
S-TRACadjuvantaxitinibrenal cell carcinomasunitinib

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