At the American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU) last weekend, the use of pembrolizumab as a treatment to stop the cancer from coming back after surgery was looked at in different groups of patients. The groups were based on the risk of the disease returning and the stage of the cancer when the patient entered the study.

The results from this clinical trial were reported last year. The results showed that after 2.5 years adjuvant pembrolizumab reduced the risk of the cancer returning by about one third. Also, the number of patients experiencing serious or life-threatening side effects with pembrolizumab was less than 10%.

994 patients were enrolled in the trial, of which nearly three quarters had moderate risk disease and 20% had high risk disease. The remaining patients (6%) had metastases that had been removed and they were cancer free. Patients were followed-up for 30 months.

The results were consistent with those already reported. Of all the groups looked at, the patients who had had metastases removed leaving them without any evidence of disease, had the biggest difference in survival compared to placebo (78.4% versus 37.9% after 2 years).

The results from the different groups of patients according to risk and stage of disease are consistent with previous results from this trial: Adjuvant pembrolizumab improves disease-free survival in all patients with high-risk kidney cancer compared to placebo. These results further support the use of adjuvant pembrolizumab as a standard treatment for patients with kidney cancer at high risk of recurrence.

However, patients should consider their situation carefully with their doctor and discuss the potential risks and benefits of adjuvant pembrolizumab. Without a test to predict which patients might benefit from treatment or who might suffer serious side effects, some patient may be given treatment that they don’t need, and they may suffer from the potentially serious side effects of pembrolizumab unnecessarily. This needs careful consideration.

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