The following articles from various urology conferences in 2018 summarise the status of research with respect to adjuvant therapy after nephrectomy for people with localised renal cell carcinoma (RCC).
Many adjuvant therapies have been assessed in clinical trials, such as radiotherapy, vaccines, immunotherapy, vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI), and checkpoint inhibitors. There have been five clinical trials to look at the effect of VEGF treatments in people with non-metastatic RCC who have had partial or radical nephrectomy: ASSURE, S-TRAC, PROTECT, SORCE, and ATLAS.
The ASSURE, S-TRAC and PROTECT clinical trials have all published their results, and a meta-analysis has been performed for disease-free survival (DFS) and overall survival (OS).
Ongoing clinical trials include EVEREST with adjuvant mTOR inhibitor, E2810 with adjuvant pazopanib, and PROSPER, IMMotion, KEYNOTE, and CheckMate looking at adjuvant immunotherapies. The immunotherapies have impressive clinical activity in patients with metastatic RCC, so it is hopeful that they will be successful in the adjuvant setting. Also, these latter clinical trials are targeting people with RCC at high risk of recurrence and are testing the biomarkers for treatment and prognosis in these patients. Additionally, immunotherapies may be better tolerated than VEGF TKIs.
In conclusion, these articles state that there is no overall survival benefit in the adjuvant VEGF TKI trials reported so far, but there may be a disease-free survival benefit. Ongoing trials may shed light on the use of VEGF TKIs as adjuvant therapies, but immunotherapies may prove to be more beneficial, especially for people with high-risk localised RCC.
Red these articles in UroToday here:
Adjuvant therapy for renal cell carcinoma
AUA 2018: Systematic Review and Meta-Analysis of Adjuvant Therapy After Nephrectomy for High-risk, Non-metastatic Renal Cell Carcinoma
EAU 2018: High Competing Risks Minimize Real-World Utility of Adjuvant Targeted Therapy in Renal Cell Carcinoma: A Population-Based Analysis
ASCO GU 2018: Association of Age and Sex with Mortality Following Adjuvant Therapy for Renal Cell Cancer: Subgroup Analysis of the ASSURE (E2805) Trial
ASCO GU 2018: Status of Adjuvant Therapy in Renal Cell Carcinoma in 2018: Completed Trials and What Is Being Tested?
ESOU18: The Role of Neoadjuvant and Adjuvant Therapy in Kidney Cancer