Kidney Cancer Research Network of Canada consensus statement on the role of adjuvant therapy after nephrectomy for high-risk, non-metastatic renal cell carcinoma: A comprehensive analysis of the literature and meta-analysis of randomized controlled trials

被引：14

作者：

Karakiewicz, Pierre I. ^{[1
]}

Zaffuto, Emanuele ^{[1
,2
,3
]}

Kapoor, Anil ^{[4
]}

Basappa, Naveen S. ^{[5
]}

Bjarnason, Georg A. ^{[6
]}

Blais, Normand ^{[7
]}

Breau, Rodney H. ^{[8
,9
,10
]}

Canil, Christina ^{[10
,11
]}

Drachenberg, Darrel ^{[12
]}

Hotte, Sebastien J. ^{[13
]}

Jeldres, Claudio ^{[14
]}

Jewett, Michael A. S. ^{[15
,16
]}

Kassouf, Wassim ^{[17
]}

Kollmannsberger, Christian ^{[18
,19
]}

Lavallee, Luke T. ^{[8
,9
,10
]}

Maloni, Ranjena ^{[15
,16
]}

Patenaude, Francois ^{[20
,21
]}

Pouliot, Frederic ^{[22
]}

Reaume, M. Neil ^{[10
,11
]}

Sabbagh, Robert ^{[14
]}

Shayegan, Bobby

So, Alan ^{[23
]}

Soulieres, Denis ^{[24
]}

Tanguay, Simon ^{[17
]}

Wood, Lori ^{[25
]}

Bandini, Marco ^{[1
,2
,3
]}

机构：

[1] Univ Montreal, Hlth Ctr, Montreal, PQ, Canada

[2] Osped San Raffaele, IRCCS, URI, Div Oncol,Unit Urol, Milan, Italy

[3] Univ Vita Salute San Raffaele, Milan, Italy

[4] McMaster Univ, Div Urol, Hamilton, ON, Canada

[5] Univ Alberta, Cross Canc Inst, Dept Oncol, Edmonton, AB, Canada

[6] Univ Toronto, Sunnybrook Odette Canc Ctr, Div Med Oncol Hematol, Toronto, ON, Canada

[7] CHU Montreal, Div Med Oncol Hematol, Montreal, PQ, Canada

[8] Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[9] Ottawa Hosp, Res Inst, Div Urol, Ottawa, ON, Canada

[10] Univ Ottawa, Ottawa, ON, Canada

[11] Ottawa Hosp, Canc Ctr, Div Med Oncol, Ottawa, ON, Canada

[12] Univ Manitoba, Sect Urol, Winnipeg, MB, Canada

[13] Juravinski Canc & McMaster Univ, Hamilton, ON, Canada

[14] CHU Sherbrooke, Sherbrooke, PQ, Canada

[15] Univ Hlth Network, Princess Margaret Canc Ctr, Dept Surg Urol, Toronto, ON, Canada

[16] Univ Hlth Network, Princess Margaret Canc Ctr, Dept Surg Oncol, Toronto, ON, Canada

[17] McGill Univ, Div Urol, Montreal, PQ, Canada

[18] British Columbia Canc Agency, Vancouver Canc Ctr, Div Med Oncol, Vancouver, BC, Canada

[19] Univ British Columbia, Vancouver, BC, Canada

[20] Sir Mortimer B Davis Jewish Hosp, Hematol Serv, Dept Med, Montreal, PQ, Canada

[21] McGill Univ, Montreal, PQ, Canada

[22] Univ Laval, Dept Surg, Div Urol, Quebec City, PQ, Canada

[23] Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada

[24] CHU Montreal, Div Med Oncol Hematol, Montreal, PQ, Canada

[25] Dalhousie Univ, Dept Med & Urol, Halifax, NS, Canada

来源：

CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL | 2018年 / 12卷 / 06期

关键词：

SUNITINIB; SORAFENIB;

D O I：

10.5489/cuaj.5187

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: The Kidney Cancer Research Network of Canada (KCRNC) collaborated to prepare this consensus statement about the use of target agents as adjuvant therapy in patients with non-metastatic renal cell carcinoma (nmRCC) after nephrectomy. We reviewed the published data and performed a meta-analysis of studies that focused on vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs). Methods: A systematic literature search identified seven trials on adjuvant target therapy in nmRCC. Three trials, the ASSURE, S-TRAC, and PROTECT, focused on VEGFR TKIs and represented the focus of the study, including a meta-analysis combining their data on disease-free survival (DFS) and overall survival (OS). Results: The ASSURE trial showed no DFS or OS benefit of TKIs over placebo after one year of adjuvant sorafenib or sunitinib. In contrast, the S-TRAC trial showed improved DFS after one year of adjuvant sunitinib using central review process, but not using investigator review process. No OS benefit was recorded in either study. Recently, the PROTECT trial also showed no DFS or OS benefit when one year of adjuvant pazopanib was compared to placebo. Meta-analyses of the pooled DFS and OS estimates from all three trials resulted in DFS and OS hazard ratios of 0.87 (95% confidence interval [CI] 0.73-1.04) and 1.04 (95% CI 0.89-1.22), respectively. Conclusions: Data from three available clinical trials of adjuvant VEGFR TKIs vs. placebo do not currently support the use of adjuvant TKI therapy as standard of care after nephrectomy for nmRCC. At this time, adjuvant TKI-based adjuvant therapy is not recommended for routine use after nephrectomy for high-risk nmRCC, but highly motivated patients may benefit from a discussion with their oncologist regarding the risks and benefits of adjuvant TKI.

引用

页码：173 / 180

页数：8

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