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Adjuvant therapy for renal cell carcinoma in 2023: hopes and disappointments
Ilya Tsimafeyeu1, Michael F Basin2, Gennady Bratslavsky2
1Bureau for Cancer Research, 526 West 158th str., New York, NY, 10032, USA. tsimafeyeu@gmail.com.
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.
Insights
Adjuvant therapy for high-risk clear cell renal cell carcinoma (ccRCC) shows limited success. While targeted therapies and some checkpoint inhibitors failed, adjuvant pembrolizumab offers hope for improved disease-free survival, especially after metastasis removal.
Area of Science:
- Oncology
- Nephrology
- Translational Research
Background:
- Clear cell renal cell carcinoma (ccRCC) has a 30% risk of progression post-surgery.
- High-risk ccRCC patients require effective adjuvant therapies after nephrectomy or metastasis resection.
Purpose of the Study:
- To review recent studies on adjuvant therapy for high-risk ccRCC.
- To evaluate the efficacy of targeted therapy and checkpoint inhibitors in the adjuvant setting.
Main Methods:
- Analysis of randomized trials in high-risk ccRCC patients.
- Evaluation of targeted therapy and immune checkpoint inhibitors.
Main Results:
- Targeted therapy showed no significant reduction in risk or improvement in overall survival.
- Adjuvant nivolumab, ipilimumab, and atezolizumab did not improve disease-free survival.
- Pembrolizumab demonstrated a significant improvement in disease-free survival, particularly in patients post-metastasectomy.
Conclusions:
- Current adjuvant therapies for high-risk ccRCC have not achieved substantial success.
- Adjuvant pembrolizumab shows promise for high-risk patients, including those with resected metastases.
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