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The 2022 American Urological Association (AUA) Annual Meeting included a session from the Society of Urologic Oncology (SUO). During this session it was discussed whether everyone should receive medication after surgery for high risk kidney cancer (adjuvant therapy). It was noted during the presentation that the perfect adjuvant therapy would not be expensive, easy to tolerate, able to kill cancer cells that cannot be seen on scans, and would results in good survival outcomes for patients. Until recently, adjuvant therapy for high-risk kidney cancer is an unmet need, as shown by a number of clinical trials with tyrosine kinase inhibitors, such as sunitinib, sorafenib, pazopanib and axitinib.
This presentation concluded by discussing whether everyone should receive adjuvant therapy after surgery for high-risk kidney cancer. The following points were made:
- Adjuvant pembrolizumab is not cheap and is not particularly easy to tolerate
- Adjuvant pembrolizumab may kill cancer cells that cannot be seen on scans
- So far, adjuvant therapy with pembrolizumab has not been shown to improve survival in patients with high-risk kidney cancer
- The patients that are potentially most likely to benefit are those who have had metastases removed and there is no evidence of the cancer, patients with one or more lymph nodes containing cancer cells, or patients with stage 3 cancer and a sarcomatoid tumour larger than 7 cm.