Cancer Management and Research (Oct 2022)

Optimal Choice of Adjuvant Treatment for Renal Cell Carcinoma Following Nephrectomy

  • Bottiglieri A,
  • Sepe P,
  • Stellato M,
  • Pircher C,
  • Fotia G,
  • Leone AG,
  • Guadalupi V,
  • Claps M,
  • Giannatempo P,
  • Verzoni E,
  • Procopio G

Journal volume & issue
Vol. Volume 14
pp. 3071 – 3081

Abstract

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Achille Bottiglieri, Pierangela Sepe, Marco Stellato, Chiara Pircher, Giuseppe Fotia, Alberto Giovanni Leone, Valentina Guadalupi, Melanie Claps, Patrizia Giannatempo, Elena Verzoni, Giuseppe Procopio Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, ItalyCorrespondence: Achille Bottiglieri, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan, Italy, Tel +39 02 2390 2751, Email [email protected]: Renal cell carcinoma (RCC) is the fourteenth most common cancer worldwide. In about 55% of cases, it is diagnosed at a localised and/or locally advanced stage and therefore amenable to a curative approach. Although nephrectomy still represents the cornerstone of non-metastatic RCC (nmRCC) treatment, a relapse is observed in about 25– 30% of patients undergoing curative surgery. Prognosis is drastically influenced by lymph nodal involvement. After the first disappointing results with a cytokine-based strategy, tyrosine kinase inhibitors (TKIs) were tested as adjuvant agents. Despite their efficacy in the metastatic setting, results in terms of disease-free survival (DFS) are not unequivocal and the overall survival (OS) benefit has not been demonstrated. Moreover, their toxicity profile induced a remarkable percentage of patients to discontinue the treatment. On the contrary, the KEYNOTE-564 trial showed the benefit of adjuvant pembrolizumab compared with placebo in terms of DFS with promising results in term of OS. Patients included were at intermediate or high risk of relapse, or patients with no evidence of disease after metastasectomy (M1 NED). The updated analysis presented at the American Society of Clinical Oncology Genito-Urinary (ASCO GU) 2022 confirmed the benefit of pembrolizumab versus placebo over time, although OS data are still immature. A longer follow-up and the several ongoing trials with immune checkpoint inhibitors (ICIs) will provide further data about adjuvant immuno-oncology (IO). Furthermore, the patients’ selection based on clinical or biological features will be crucial in order to identify who benefits most from treatments.Keywords: RCC, post-operative, TKIs, immunotherapy, clear cell, pembrolizumab

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