The 2022 Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitor Therapy for Renal Cell Carcinoma |
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| Institution: | 1. Department of Urology, University Hospital Tübingen, Tübingen, Germany;2. German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany;3. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France;4. Department of Urology, San Raffaele Scientific Institute, Milan, Italy;5. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy;6. International Kidney Cancer Coalition, Duivendrecht, The Netherlands;7. Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic;8. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden;9. Department of Urology, Coimbra University Hospital, Coimbra, Portugal;10. Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany;11. Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy;12. Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel;13. Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden;14. Department of Urology, Cabueñes University Hospital, Gijón, Spain;15. Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden;p. Department of Urology, Homerton University Hospital, London, UK;q. The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK;r. The Royal Free London NHS Foundation Trust, London, UK;s. UCL Division of Surgery and Interventional Science, University College London, London, UK;t. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;1. Department of Urology, University Hospital Tübingen, Tübingen, Germany;2. German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany;3. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France;4. Department of Urology, San Raffaele Scientific Institute, Milan, Italy;5. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy;6. International Kidney Cancer Coalition, Duivendrecht, The Netherlands;7. Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic;8. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden;9. Department of Urology, Coimbra University Hospital, Coimbra, Portugal;10. Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany;11. Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy;12. Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel;13. Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden;14. Department of Urology, Cabueñes University Hospital, Gijón, Spain;15. Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden;p. Department of Urology, Homerton University Hospital, London, UK;q. The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK;r. The Royal Free London NHS Foundation Trust, London, UK;s. UCL Division of Surgery and Interventional Science, University College London, London, UK;t. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands |
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| Abstract: | In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the trial until final overall survival data and results from other trials were available. Meanwhile, the primary DFS endpoints were not met for adjuvant atezolizumab (PD-L1 inhibitor; IMmotion010), adjuvant nivolumab plus ipilimumab (CheckMate 914), or perioperative nivolumab (PROSPER). Owing to heterogeneity, a meta-analysis is not recommended. Pembrolizumab remains the only immune checkpoint inhibitor currently recommended in this setting. Overall survival data are immature and biomarkers to predict outcome are lacking. Uncertainty exists and overtreatment is occurring. Treatment decisions should be made with caution and with the involvement of each patient.Patient summaryNew results from three trials of immunotherapy after surgery for kidney cancer to reduce the risk of recurrence showed no improvement with these treatments. These results are in contrast to an earlier study that showed that the antibody pembrolizumab did extend the time before kidney cancer recurrence, even though it is not yet clear if overall survival is longer. Thus, we cautiously recommend pembrolizumab as additional treatment in high-risk kidney cancer after surgery, but patient preference should be carefully considered and the risk of overtreatment should be discussed. |
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| Keywords: | Adjuvant Pembrolizumab Tyrosine kinase inhibitor High risk Metastasectomy Clear cell Renal cell carcinoma |
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