Adjuvant therapy in renal cell carcinoma in the immunotherapy era: where do we stand?

ABSTRACT

Locoregional, as well as metastatic renal cell carcinoma, tends to relapse after nephrectomy or metastasectomy. Adjuvant therapy seems to be an effective strategy to reduce the risk of recurrence. All anti-VEGF tyrosine kinase inhibitors except sunitinib have failed to show any benefit in the adjuvant setting in patients with locally advanced disease and an intermediate-to-high chance of recurrence. On the other hand, immune checkpoint inhibitors, which are now used in the first-line in the metastatic setting, are being tested in the adjuvant setting. Pembrolizumab has shown benefit in the adjuvant setting in patients with a high risk of recurrence or with resected metastatic disease with no evidence of disease. Results for other checkpoint inhibitors are still awaited.

Advanced and metastatic kidney cancer often tend to relapse after surgery. Treatment maintenance after surgery could be an effective strategy to reduce the risk of recurrence. Anti-VEGF tyrosine kinase inhibitors are the standard of care in the treatment of metastatic kidney cancer. However, they have all (but one) failed to prevent the occurrence of metastases in advanced nonmetastatic kidney cancer. On the other hand, immunotherapy is now being tested as a postsurgery treatment to prevent disease recurrence. Pembrolizumab has shown efficacy in preventing recurrence and is now approved as a postsurgery drug in advanced kidney cancer.