Perioperative Immune-Checkpoint Inhibition in Renal Cell Carcinoma: Lessons Learned and Future Directions

Area of Science:

• Oncology
• Immunotherapy
• Renal Cell Carcinoma Research

Background:

• Localized renal cell carcinoma (RCC) has a significant rate of metastatic recurrence.
• Immune-checkpoint inhibition (ICI), a form of immunotherapy, is increasingly used for various localized cancers.
• The efficacy of ICI in localized RCC requires further investigation.

Purpose of the Study:

• To review recent literature on ICI in localized RCC.
• To highlight key findings and lessons from clinical trials.
• To propose future research directions leveraging new technologies.

Main Methods:

• Systematic review of English-language articles from PubMed, Google Scholar, and Scopus.
• Prioritization of prospective clinical trials.
• Focus on disease-free survival (DFS), overall survival (OS), and clinical trial design.

Main Results:

• KEYNOTE-564 trial showed DFS and OS benefits for adjuvant pembrolizumab in high-risk clear cell RCC.
• Conflicting results from IMmotion-010 and CheckMate-914 trials regarding adjuvant ICI.
• Preliminary RAMPART trial data suggest DFS benefit for adjuvant durvalumab-tremelimumab.
• PROSPER trial found no benefit for perioperative nivolumab; ongoing trials show promise.
• Subtle but significant differences in clinical trial designs noted.
• Novel diagnostic tools and technologies for RCC identified.

Conclusions:

• Lessons from clinical trial design differences are crucial for optimizing ICI use.
• New diagnostic tools and technologies can improve risk stratification in localized RCC.
• Personalized approaches using perioperative ICI hold potential for select patient groups.