Adjuvant Therapy in Renal Cell Carcinoma: Are We Ready for Prime Time?

Wang, Luke L.; Saidian, Ava; Pan, Elizabeth; Panian, Justine; Derweesh, Ithaar; McKay, Rana R.

doi:10.3233/kca-220014

Cited by 3 publications

(5 citation statements)

References 40 publications

(25 reference statements)

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“…In addition to the TNM staging, higher tumor grade is associated with increased disease recurrence independent of tumor stage [ 4 ]. Many nomograms have been developed combining the TNM staging system with additional clinical and pathologic factors (e.g., tumor grade, histologic features, performance status, tumor necrosis, clinical symptoms, and margin status) to aid in prognostication in the localized disease [ 5 ]. Currently, there is no validated biomarker beyond traditional clinical characteristics and histopathology in localized RCC.…”

Section: Treatment Of Localized Diseasementioning

confidence: 99%

“…Cytokine therapy, vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI), and mammalian target of rapamycin (mTOR) inhibitors were investigated in the adjuvant setting with mixed results [ 5 , 14 ]. Sunitinib is the only FDA-approved VEGF TKI in resected high-risk ccRCC based on the positive phase III S-TRAC trial [ 15 ].…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…The promising results of KEYNOTE 564 was accompanied by a series of parallel negative adjuvant trials investigating other ICIs [ 5 ] (Table 1 ). The trials differed with regard to eligibility criteria, treatment, and design.…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…These negative studies raised debates regarding whether the efficacy of ICIs exist in the adjuvant setting for RCC. There are many nuances that may explain the negative findings which are beyond the scope of this review [ 5 ]. In addition, cross-trial comparison is always challenging.…”

Section: Adjuvant Therapymentioning

confidence: 99%

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Treatment Landscape of Renal Cell Carcinoma

Chen,

Wang,

Panian

et al. 2023

Curr. Treat. Options in Oncol.

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Opinion StatementThe treatment landscape of renal cell carcinoma (RCC) has evolved significantly over the past three decades. Active surveillance and tumor ablation are alternatives to extirpative therapy in appropriately selected patients. Stereotactic body radiation therapy (SBRT) is an emerging noninvasive alternative to treat primary RCC tumors. The advent of immune checkpoint inhibitors (ICIs) has greatly improved the overall survival of advanced RCC, and now the ICI-based doublet (dual ICI-ICI doublet; or ICI in combination with a vascular endothelial growth factor tyrosine kinase inhibitor, ICI-TKI doublet) has become the standard frontline therapy. Based on unprecedented outcomes in the metastatic with ICIs, they are also being explored in the neoadjuvant and adjuvant setting for patients with high-risk disease. Adjuvant pembrolizumab has proven efficacy to reduce the risk of RCC recurrence after nephrectomy. Historically considered a radioresistant tumor, SBRT occupies an expanding role to treat RCC with oligometastasis or oligoprogression in combination with systemic therapy. Furthermore, SBRT is being investigated in combination with ICI-doublet in the advanced disease setting. Lastly, given the treatment paradigm is shifting to adopt ICIs at earlier disease course, the prospective studies guiding treatment sequencing in the post-ICI setting is maturing. The effort is ongoing in search of predictive biomarkers to guide optimal treatment option in RCC.

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Section: Treatment Of Localized Diseasementioning

confidence: 99%

Section: Adjuvant Therapymentioning

confidence: 99%

Section: Adjuvant Therapymentioning

confidence: 99%

Section: Adjuvant Therapymentioning

confidence: 99%

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Treatment Landscape of Renal Cell Carcinoma

Chen,

Wang,

Panian

et al. 2023

Curr. Treat. Options in Oncol.

Self Cite

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“…Additionally, the consideration of toxicity is also very important, as ICIs may induce immune-related AEs, necessitating a meticulous risk-benefit evaluation. Moreover, the utilization of ICIs as adjuvant therapy can significantly impact subsequent treatment decisions in cases of disease relapse with metastasis [31]. The selection between TKIs and ICIs in adjuvant RCC therapy is complex.…”

Section: Comparing Io and Tkis In The Adjuvant Settingmentioning

confidence: 99%

The Future of Adjuvant Therapy in Renal Cell Carcinoma: Recent Insights and Prospects

Ha,

Lim

2023

J Urol Oncol

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Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.

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Lenvatinib and pembrolizumab combination in metastatic renal cell carcinoma: experience of the Republic of Bashkortostan

Menshikov,

Lipatov,

Nasretdinov

et al. 2024

Onkourologiâ

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Background. Lenvatinib and pembrolizumab combination showed statistically significant and clinically important improvements for progression-free survival (PFS), overall survival (OS), and objective response rate compared to sunitinib.Aim. To evaluate the effectiveness and safety of lenvatinib and pembrolizumab combination in patients with metastatic renal cell carcinoma in clinical practice at the Republican Clinical Oncological Dispensary (Ufa).Materials and methods. The study included 24 patients (20 men and 4 women) with clear cell renal cell carcinoma. Patients with ECOG (Eastern Cooperative Oncology Group) score 0–3, any Karnofsky scale status, and no detection of PD-L1 expression in the tumor were included. Follow-up period was 24 months.Results. Objective response rate was 68 % which is consistent with the CLEAR trial value of 72 %. Six-month PFS was 82 %, 12-month PFS was 70 %; 6-month OS was 91.2 %, 12-month OS was 83.4 %. Median PFS and OS were not reached. There were no new safety signals for the lenvatinib and pembrolizumab combination. Grade III adverse events were arterial hypertension and hepatotoxicity.Conclusion. In real clinical practice, lenvatinib and pembrolizumab combination showed results consistent with the data of the basic clinical trial despite short follow-up and expanded inclusion criteria.

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Adjuvant Therapy in Renal Cell Carcinoma: Are We Ready for Prime Time?

Cited by 3 publications

References 40 publications

Treatment Landscape of Renal Cell Carcinoma

Treatment Landscape of Renal Cell Carcinoma

The Future of Adjuvant Therapy in Renal Cell Carcinoma: Recent Insights and Prospects

Lenvatinib and pembrolizumab combination in metastatic renal cell carcinoma: experience of the Republic of Bashkortostan

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