Treatment of people with intermediate to high risk renal cell carcinoma (RCC) with medicine to prevent the cancer from coming back (adjuvant therapy) can benefit some patients, but it’s important for each patient to weigh the treatment benefit and potential risk of side effects on quality of life.
Adjuvant therapy has been shown to delay cancer recurrence, but side effects may affect a patient’s quality of life. These risks and benefits should be based on patient preference.
Two medicines have been tested as adjuvant therapy for intermediate to high risk RCC: sunitinib and pembrolizumab. Sunitinib has been shown to improve disease-free survival compared with placebo; however, 48% of patients experienced severe side effects, such as high blood pressure, a rash on the hands and feet, mouth ulcers, nausea and diarrhoea. Sunitinib was approved by the Food and Drug Administration (FDA) in 2017 as a adjuvant therapy for RCC and is available in the USA, but real-world use is not widespread due to the limited benefit and high occurrence of side effects.
Pembrolizumab is just going through the approval process for use on the NHS. In clinical trials, one year of pembrolizumab treatment was shown to improve disease-free survival compared with placebo, and is well tolerated for the majority of patients. However, some patient experience immune-related side effects including rash, diarrhoea, thyroid inflammation, alterations in the pancreas and inflammation in the liver, lungs and kidneys. Most of these side effects are manageable with steroids. For a small number of patients, the side effects can be severe and potentially fatal, making it important for patients to be aware of them and to recognise them early. Side effects can affect quality of life, but when comparing pembrolizumab with placebo, there was no significant difference in quality of life.