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At the 2023 Society of Urologic Oncology (SUO) Annual Meeting, Dr Grant Stewart from Addenbrookes Hospital in Cambridge, UK reviewed neoadjuvant therapy to help manage patients with localised kidney cancer (kidney cancer that has not spread to other organs, but has grown to a large size in the kidney). Neoadjuvant therapy is treatment that is given before surgery to help shrink the tumour and make it easier to remove.
There have been a number of trials looking at targeted therapies and immunotherapy, as well as combinations. Most of these trials were small phase 1 or 2 trials with small numbers of patients. The most promising medicine as a neoadjuvant therapy was axitinib, where nearly half of the patients had a partial response to treatment and their tumour shrank and the average reduction in the size of the tumour was more than a quarter.
Other medicines that have been tested as neoadjuvant therapies are nivolumab, and avelumab and axitinib, but none of these resulted in better responses than axitinib alone. However, in the axitinib trial, survival was not measured.
There are 11 ongoing neoadjuvant kidney cancer clinical trials, and only 2 of the studies are randomised and none of the trials have survival end points. Dr Stewart suggested that clinical trials will move away from single medicines and he described a study called WIRE, which is taking place at Addenbrookes.