RESUMEN
Adjuvant treatment with VEGFR tyrosine kinase inhibitor in renal cell carcinoma after nephrectomy has been reported through four clinical trials: S-TRAC, ASSURE, PROTECT and ATLAS. Only S-TRAC has been significantly positive on primary endpoint DFS under sunitinib compared to placebo, whereas ASSURE, PROTECT and ATLAS did not show any gain under sunitinib, sorafenib, pazopanib or axitinib, respectively. Nevertheless, there are arguments for a trend for the impact of anti-angiogenic therapy on outcome of patients with high-risk renal cell carcinoma cancer following nephrectomy, allowing for a fair discussion with patients to decide for or against an adjuvant treatment.
Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Quimioterapia Adyuvante/métodos , Neoplasias Renales/tratamiento farmacológico , Nefrectomía/métodos , Carcinoma de Células Renales/mortalidad , Supervivencia sin Enfermedad , Humanos , Neoplasias Renales/mortalidadRESUMEN
Adjuvant treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitor in renal cell carcinoma after nephrectomy has been reported through three clinical trials: S-TRAC, ASSURE and PROTECT. Only S-TRAC has been significantly positive on primary end-point disease-free survival under sunitinib compared to placebo, whereas ASSURE and PROTECT did not show any gain under sunitinib, sorafenib or pazopanib. This short review presents the differences between the trials and provides hypotheses on why S-TRAC may have been positive.
Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Quimioterapia Adyuvante/métodos , Neoplasias Renales/tratamiento farmacológico , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/cirugía , Terapia Combinada/métodos , Terapia Combinada/mortalidad , Supervivencia sin Enfermedad , Humanos , Indazoles , Neoplasias Renales/mortalidad , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía , Supervivencia sin Progresión , Pirimidinas/uso terapéutico , Sorafenib/uso terapéutico , Sulfonamidas/uso terapéutico , Sunitinib/uso terapéuticoRESUMEN
Recent advances in advanced renal cell cancer (RCC) research have produced new drugs and therapies for patients with metastatic disease leading to higher response rates, improvements in progression-free survival, and longer overall survival. These advances have yet to be realized in patients with early-stage kidney cancer, and to date, no drug has been approved for the adjuvant treatment of localized kidney cancer. The current standard of care for localized high-risk kidney cancers is resection of the primary tumor. Here, we review the results of recently completed adjuvant vascular endothelial growth factor receptor 2 (VEGFR2) tyrosine kinase inhibitor (TKI) trials in RCC that have been reported, or are awaiting results. Further, we discuss the new immune checkpoint inhibitor adjuvant trials planned. There is hope that these trials may lead to new options and longer survival for patients with localized high-risk kidney cancer.
Asunto(s)
Carcinoma de Células Renales/terapia , Inmunoterapia/métodos , Factor A de Crecimiento Endotelial Vascular/inmunología , Carcinoma de Células Renales/patología , HumanosRESUMEN
At the present time, the standard of care for patients who have received nephrectomy for localized renal cell carcinoma (RCC) is radiographic surveillance. With a number of novel targeted agents showing activity in the setting of metastatic RCC, there has been great interest in exploring the potential of the same agents in the adjuvant setting. Herein, we discuss the evolution of adjuvant trials in RCC, spanning from the immunotherapy era to the targeted therapy era. Pitfalls of current studies are addressed to provide a context for interpreting forthcoming results. Finally, we outline avenues to incorporate promising investigational agents, such as PD-1 (programmed death-1) inhibitors and MNNG transforming gene inhibitors, in future adjuvant trials.