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

Here we explore the recent and relevant trials for treatment of renal cell cancer (RCC) in the adjuvant and neoadjuvant settings as well as recent updates to the guidelines for RCC management.

Most phase III studies of tyrosine kinase inhibitors in the adjuvant setting have been negative. Notably, sunitinib received regulatory approval by the FDA after showing improved disease-free survival in high risk populations. Recent improvements in the genetic classification and understanding of RCC molecular and genetic disorder will hopefully improve patient selection. Meanwhile, recent advances in metastatic RCC treatment, particularly with the combination of tyrosine kinase inhibitors and immune checkpoint inhibitors, have given rise to hope that advances can be made by moving these treatment strategies forward to the adjuvant or neoadjuvant settings.

In the absence of a clinical trial, observation remains the standard of care. Based on the S-TRAC data, sunitinib is approved for use in the adjuvant setting, and can be considered under select circumstances. Although there is optimism for checkpoint monotherapy and combination therapy in the adjuvant or neoadjuvant setting, ongoing studies will determine clinical benefit and tolerability in this setting. Therefore, for patients with high risk of recurrent disease clinical trials of checkpoint inhibitor therapy are viable options.

Current opinion in urology. 2019 Jul 24 [Epub ahead of print]

Jack P Gleeson, Robert J Motzer, Chung-Han Lee

Department of Medicine, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.