SUO 2017: Neoadjuvant Therapies in Kidney Cancer: Critique, Current Trials and Future Directions

Washington, DC ( Dr. Voss began his talk asking what the rationale was for using neoadjuvant rather than adjuvant therapy in patients undergoing nephrectomy in curative intent.  Neoadjuvant chemotherapy is an established standard with improved outcomes in various solid malignancies. It might also facilitate resectability and optimize organ preservation. Furthermore, GFR may be superior before nephrectomy, when compared to after nephrectomy. Despite these important points, all recent phase 3 perioperative trials in renal cell carcinoma (RCC) were done in the adjuvant setting (EVEREST, ASSURE, S-TRAC, PROTECT, SORCE, and ATAS).

Dr. Voss then discussed specific considerations for targeted immunotherapy with checkpoint inhibitors (CPI) in the neoadjuvant approach. There has been a xenograft model showing data supportive of neoadjuvant over adjuvant PD1 directed therapy. There is also a pilot study performed at MSKCC, assessing neoadjuvant Nivolumab for high risk non-metastatic RCC. Several questions arise for this setting. This includes how close to nephrectomy can the last dose be given? how long do we need to treat pre-operatively for meaningful effect? How much can nephrectomy safely be delayed? should CPI therapy be continued after nephrectomy? And lastly should we target specific patient populations? These questions will be answered in the upcoming clinical trials.

Presented by: Martin Voss, MD Medical Oncologist, Memorial Sloan Kettering Cancer Center , NY, NY

Written by: Hanan Goldberg, MD @GoldbergHanan Society of Urologic Oncology Fellow University of Toronto, Princess Margaret Cancer Centre at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC