Adjuvant Therapy in Renal Cell Carcinoma: Current Status and Future Directions

被引:1
作者
Kazarian, Austin G. [1 ]
Chawla, Neal S. [2 ]
Muddasani, Ramya [2 ]
Pal, Sumanta K. [2 ]
机构
[1] Univ Iowa, Carver Coll Med, Iowa City, IA USA
[2] City Hope Comprehens Canc Ctr, Dept Med Oncol & Expt Therapeut, 1500 East Duarte Rd, Duarte, CA 91010 USA
关键词
Renal cell carcinoma; adjuvant chemotherapy; cytokines; molecular targeted therapy; precision medicine; BLIND PHASE-III; HIGH-RISK; RADICAL NEPHRECTOMY; INTERFERON-ALPHA; TRIAL; INTERLEUKIN-2; STAGE; RECURRENCE; SURVIVAL; IMMUNOTHERAPY;
D O I
10.3233/KCA-200105
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
In recent years, incredible progress has been made in the treatment of metastatic renal cell carcinoma, with a paradigm shift from the use of cytokines to tyrosine kinase inhibitors, and more recently, immune checkpoint inhibitors (ICIs). Despite advances in the metastatic setting, effective therapies in the adjuvant setting are a largely unmet need. Currently, sunitinib (Sutent, Pfizer) is the only therapy for the adjuvant treatment of RCC included in the National Comprehensive Cancer Network guidelines, which was approved by the FDA based on the improvement in disease-free survival (DFS) seen in the S-TRAC trial. However, improvement in DFS has not translated into an overall survival (OS) benefit for patients at high-risk of relapse post-nephrectomy, illustrating the need for more effective therapies. This manuscript will highlight attributes of both historical and current drug trials and their implications on the landscape of adjuvant therapy. Additionally, we will outline strategies for selecting patients in whom treatment would be most beneficial, as optimal patient selection is a crucial step towards improving outcomes in the adjuvant setting. This is especially critical, given the financial cost and pharmacological toxicity of therapeutic agents. Furthermore, we will review the design of clinical trials including the value of utilizing OS as an endpoint over DFS. Finally, we will discuss how the incorporation of genomic data into predictive models, the use of more sensitive imaging modalities for more accurate staging, and more extensive surgical intervention involving lymph node dissection, may impact outcomes.
引用
收藏
页码:9 / 20
页数:12
相关论文
共 50 条
  • [31] Systemic Treatment of Metastatic Clear Cell Renal Cell Carcinoma in 2018: Current Paradigms, Use of Immunotherapy, and Future Directions
    Lalani, Aly-Khan A.
    McGregor, Bradley A.
    Albiges, Laurence
    Choueiri, Toni K.
    Motzer, Robert
    Powles, Thomas
    Wood, Christopher
    Bex, Axel
    EUROPEAN UROLOGY, 2019, 75 (01) : 100 - 110
  • [32] Checkpoint inhibitors for renal cell carcinoma: current landscape and future directions
    Zibelman, Matthew
    Ghatalia, Pooja
    Geynisman, Daniel M.
    Plimack, Elizabeth R.
    IMMUNOTHERAPY, 2016, 8 (07) : 785 - 798
  • [33] De-escalation of Adjuvant Therapy in Operatively Managed HPV Associated Oropharyngeal Carcinoma: Current Status and Future Directions
    Ma, Daniel
    Routman, David M.
    SEMINARS IN RADIATION ONCOLOGY, 2025, 35 (02) : 166 - 172
  • [34] Adjuvant and Neoadjuvant Therapy in Renal Cell Carcinoma
    Kuusk, Teele
    Bex, Axel
    HEMATOLOGY-ONCOLOGY CLINICS OF NORTH AMERICA, 2023, 37 (05) : 907 - 920
  • [35] The emerging landscape of neo/adjuvant immunotherapy in renal cell carcinoma
    Dibajnia, Pooya
    Cardenas, Luisa M.
    Lalani, Aly-Khan A.
    HUMAN VACCINES & IMMUNOTHERAPEUTICS, 2023, 19 (01)
  • [36] Adjuvant Therapy in Adrenocortical Carcinoma: Reflections and Future Directions
    Bedrose, Sara
    Daher, Marilyne
    Altameemi, Lina
    Habra, Mouhammed Amir
    CANCERS, 2020, 12 (02)
  • [37] Front-Line Therapy for Metastatic Renal Cell Carcinoma: A Perspective on the Current Algorithm and Future Directions
    Govindarajan, Ameish
    Castro, Daniela V.
    Zengin, Zeynep B.
    Salgia, Sabrina K.
    Patel, Jalen
    Pal, Sumanta K.
    CANCERS, 2022, 14 (09)
  • [38] Current status and future perspective of immunotherapy for renal cell carcinoma
    Blas, Leandro
    Monji, Keisuke
    Mutaguchi, Jun
    Kobayashi, Satoshi
    Goto, Shunsuke
    Matsumoto, Takashi
    Shiota, Masaki
    Inokuchi, Junichi
    Eto, Masatoshi
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY, 2024, 29 (08) : 1105 - 1114
  • [39] Systemic adjuvant therapy for renal cell carcinoma: Any hope for future clinical trials?
    Mehrazin, Reza
    Tsao, Che-Kai
    Sfakianos, John
    Galsky, Matthew D.
    UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 2016, 34 (05) : 221 - 224
  • [40] The Changing Landscape of Management of Metastatic Renal Cell Carcinoma: Current Treatment Options and Future Directions
    Salgia, Nicholas J.
    Dara, Yash
    Bergerot, Paulo
    Salgia, Meghan
    Pal, Sumanta K.
    CURRENT TREATMENT OPTIONS IN ONCOLOGY, 2019, 20 (05)