Approaches to Treating High Risk and Advanced Renal Cell Carcinoma (RCC): Key Trial Data That Impacts Treatment...

Area of Science:

• Oncology
• Nephrology
• Immunotherapy

Background:

• The treatment landscape for kidney cancer has shifted with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) and immune checkpoint inhibitors.
• Optimizing systemic therapies post-checkpoint blockade and defining the roles of neoadjuvant/adjuvant treatments and cytoreductive nephrectomy are critical.

Purpose of the Study:

• To review current evidence on systemic therapies for high-risk localized and advanced kidney cancer.
• To discuss decision-making for post-checkpoint inhibitor treatments, adjuvant/neoadjuvant therapies, and cytoreductive nephrectomy.

Main Methods:

• Review of current evidence and clinical trial data.
• Analysis of systemic therapies including VEGFR TKIs and immune checkpoint inhibitors.
• Evaluation of adjuvant/neoadjuvant strategies and cytoreductive nephrectomy.

Main Results:

• Some VEGFR TKIs show benefit post-checkpoint inhibition; combination therapies are under investigation with mixed results.
• Adjuvant pembrolizumab improved overall survival, while other adjuvant VEGFR TKI and immunotherapy trials yielded negative results.
• The role of cytoreductive nephrectomy remains debated, with ongoing studies to clarify its place in the doublet therapy era.

Conclusions:

• Treatment decisions for kidney cancer require careful consideration of evolving systemic therapies and surgical roles.
• Further research is needed to establish optimal sequencing and combinations of therapies, including the role of cytoreductive nephrectomy.