Adjuvant therapy for renal cell carcinoma: 2023 Canadian Kidney Cancer Forum consensus statement

Area of Science:

• Oncology
• Immunotherapy
• Genitourinary Cancers

Background:

• Adjuvant immune checkpoint inhibitor (ICI) therapy in renal cell carcinoma (RCC) shows varied results.
• Guidance is needed for using ICIs post-surgery for clear-cell RCC in Canada.

Purpose of the Study:

• To establish data-driven guidance for adjuvant ICI use in clear-cell RCC within a Canadian context.
• To provide expert consensus on managing patients after RCC resection.

Main Methods:

• A panel of 22 genitourinary and radiation oncologists convened.
• 14 topic statements on post-surgery RCC management were voted on.
• Consensus was defined as >75% agreement.

Main Results:

• All 14 statements reached consensus among experts.
• High-risk clear-cell RCC patients should be counselled on recurrence and adjuvant ICI therapy.
• One year of pembrolizumab is the only currently recommended adjuvant ICI regimen.
• Uncertainty remains due to inconsistent trial benefits and immature overall survival data.

Conclusions:

• This consensus provides Canadian expert guidance on adjuvant ICI therapy for post-surgical RCC.
• The rapidly evolving field necessitates ongoing evidence-based re-evaluation.