The current role for adjuvant and neoadjuvant therapy in renal cell cancer

Neoadjuvant Nivolumab in Patients with High-risk Nonmetastatic Renal Cell Carcinoma

“…Furthermore, in a followup study, the authors demonstrated a significant rate of conversion of candidacy from radical to partial nephrectomy following TKI administration [10]. Unfortunately, the significant side-effect profile and decreased quality of life experienced by patients treated with preoperative TKIs weigh against the potential benefits of this treatment strategy [2]. This contrasts with the observations of this study, where we saw relatively fewer AEs and preserved quality of life.…”

“…We Multiple randomized trials have demonstrated improved treatment outcomes in patients with metastatic renal cell carcinoma (RCC) treated with inhibitors of the immune checkpoint molecule programmed cell death protein 1 (PD-1) or its ligand PD-L1 (reviewed by Rappold et al [1]). Consequently, there is growing interest in the use of these agents in the neoadjuvant and/or adjuvant settings in patients with nonmetastatic RCC who are at a high risk of disease recurrence [2,3]. Data on the impact of neoadjuvant immune checkpoint blockade on intra-and postoperative complications are relatively limited at the present time.…”

“…Prior studies have suggested a potential role for neoadjuvant tyrosine kinase inhibitors (TKIs) to downstage tumors prior to surgical resection (reviewed by Gleeson et al [2] and Borregales et al [8]). For example, in a phase 2 trial by Karam and coworkers [9], neoadjuvant axitinib demonstrated a median 28.3% reduction in tumor diameter and 11 (45.8%) partial responses by RECIST criteria.…”

Adjuvant targeted therapy combined with surgery for advanced and metastatic renal cell carcinoma

“…Some studies including 2 famous landmark trials have pointed out that this combined therapy could degrade tumor stage and halt tumor development and reduce the size of both the original tumor and metastatic neoplasms. [ 18 , 19 ] However, there exist other reports claiming that such combination had no direct impact on tumor growth and on the contrary would bring other drug safety concerns such as provoking several adverse effects. These mainly included hand and foot syndrome, malaise, digestive problems, etc.…”

Impact of cytoreductive nephrectomy in patients with primary metastatic renal cell carcinoma receiving systemic tyrosine kinase inhibitor therapy: A multicenter retrospective study

“…CN has been a standard treatment strategy for patients with primary mRCC based on two randomized studies that compared immediate CN plus interferon-a versus interferon-a alone, and demonstrated a survival benefit in those patients. 1,2 Although systemic first-line TKI therapy has changed clinical practice, [3][4][5][6][7][8] immediate CN remained among the possible treatment selections based on several retrospective or small studies. [9][10][11][12][13][14][15][16][17][18][19] However, the clinical implication of immediate CN remains inconclusive because a randomized controlled phase 3 noninferiority trial, CAR-MENA, demonstrated that sunitinib alone was not inferior to immediate CN followed by sunitinib, in terms of OS.…”