Stereotactic Radiotherapy and Short-course Pembrolizumab for Oligometastatic Renal Cell Carcinoma—The RAPPORT Trial

Siva, Shankar; Bressel, Mathias; Wood, Simon; Shaw, Margaret; Loi, Sherene; Sandhu, Shahneen; Tran, Ben; Azad, Arun; Lewin, Jeremy; Cuff, Katharine; Liu, Howard; Moon, Daniel; Goad, Jeremy; Wong, Lih‐Ming; Lim-Joon, Michael; Mooi, Jennifer; Chander, Sarat; Murphy, Declan; Lawrentschuk, Nathan; Pryor, David

doi:10.1016/j.eururo.2021.12.006

Cited by 82 publications

(51 citation statements)

References 30 publications

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“…It is tempting to combine the recent expansion in experience with SABR with expansion in immunotherapy treatments. The RAPPORT study has been quick to adopt this approach by offering SITAR treatment, either SABR or fractionated radiotherapy to all visible metastases in oligometastatic renal cancer patients, and this study demonstrated a relatively high local control and 2‐year survival 40,56 . Turchan et al 81 .…”

Section: What Have We Learned Where Are the Deficiencies And What Wor...mentioning

confidence: 77%

“…Estimated 1-and 2-year OS was 90% and 74%, respectively, and PFS was 60% and 45%. 56 A phase III trial with this protocol could confirm the benefit compared with pembrolizumab alone.…”

Section: Renal Cancermentioning

confidence: 92%

“…The RAPPORT study has been quick to adopt this approach by offering SITAR treatment, either SABR or fractionated radiotherapy to all visible metastases in oligometastatic renal cancer patients, and this study demonstrated a relatively high local control and 2-year survival. 40,56 Turchan et al 81 also promote this approach, suggesting that immunotherapy may be more effectivewhen there is a lower volume of residual tumour burden.…”

Section: Combining Cellular Immunotherapies With Radiation Therapymentioning

confidence: 99%

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Clinical evidence for synergy between immunotherapy and radiotherapy (SITAR)

et al. 2022

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Previous preclinical and clinical trials have shown promising antitumour activity and toxicity profile when employing the 'Synergy between Immunotherapy and Radiotherapy' (SITAR) strategy. Approximately, one in seven radiation therapy studies currently recruiting is investigating SITAR. This article reviews the range of cancers known to respond to immunotherapy and publications analysing SITAR. It sets the background for work that needs to be done in future clinical trials. It also reviews the potential toxicities of immunotherapy and discusses areas where caution is required when combining treatments.

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Section: What Have We Learned Where Are the Deficiencies And What Wor...mentioning

confidence: 77%

“…Estimated 1-and 2-year OS was 90% and 74%, respectively, and PFS was 60% and 45%. 56 A phase III trial with this protocol could confirm the benefit compared with pembrolizumab alone.…”

Section: Renal Cancermentioning

confidence: 92%

Section: Combining Cellular Immunotherapies With Radiation Therapymentioning

confidence: 99%

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Clinical evidence for synergy between immunotherapy and radiotherapy (SITAR)

et al. 2022

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“…For patients receiving concurrent SABR and ICIs, several studies indicate the safety of this combination. The RAP-PORT study 106 (ClinicalTrials.gov identifier: NCT02855203) was a multi-institutional single-arm, phase I/II study of SABR and short-course pembrolizumab (eight cycles) in oligometastatic RCC. There were no grade 41 events and 13% grade 3 events.…”

Section: Clinical Questionmentioning

confidence: 99%

Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline

Rathmell

Rumble

Veldhuizen

et al. 2022

JCO

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123

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PURPOSE To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations. RESULTS The panel considered peer-reviewed reports published in English. RECOMMENDATIONS The diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC. Additional information is available at www.asco.org/genitourinary-cancer-guidelines

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“…While both our study and the RAPPORT trial focused on patients with a limited number of metastases (three or fewer and five or fewer, respectively), the RAPPORT trial included patients on systemic therapy and assessed the impact of combining SAbR with an ICI. The RAPPORT trial evaluated 30 RCC patients with five or fewer metastases treated with SAbR upfront followed by eight cycles of pembrolizumab [34].…”

Section: Discussionmentioning

confidence: 99%