Abstract
Approximately 70% of cases of kidney cancer are localized or locally advanced at diagnosis. Among patients who undergo surgery for these cancers, 30–35% will eventually develop potentially fatal metachronous distant metastases. Effective adjuvant treatments are urgently needed to reduce the risk of recurrence of kidney cancer and of dying of metastatic disease. To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit. Only two trials of an autologous renal tumour cell vaccine and of the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor sunitinib have shown positive results, but these have been criticized for methodological reasons and conflicting data, respectively. The results of two additional trials of targeted agents as adjuvant therapies have not yet been published. Novel immune checkpoint inhibitors are promising approaches to adjuvant therapy in kidney cancer, and a number of trials are now underway. An important component of the management of patients with kidney cancer, particularly those who undergo radical resection for localized renal cell carcinoma, is the preservation of kidney function to reduce morbidity and mortality. The optimal management of these patients therefore requires a multidisciplinary approach involving nephrologists, oncologists, urologists and pathologists.
Key points
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Effective adjuvant treatments for kidney cancer are needed to reduce the risk of recurrence and of dying of metastatic disease.
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To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit in clinical trials; the two positive trials were criticized for methodological reasons and conflicting results.
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Only one drug — sunitinib — has been approved for the adjuvant treatment of kidney cancer in the USA; however, this drug has not been approved as an adjuvant therapy in Europe.
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Positive results with immune checkpoint inhibitors in metastatic renal cell carcinoma (RCC) suggest that these agents might also be effective adjuvant therapies; trials of these agents are underway.
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Preservation of kidney function in patients with RCC is important to reduce morbidity; therefore, multidisciplinary management should be mandatory for almost all patients with radically resected kidney cancer.
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Nature Reviews Nephrology thanks H. Hammers, M. H. Rosner and the other anonymous reviewer(s) for their contribution to the peer review of this work.
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C.P. and A.B. contributed to the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) discussion regarding approval of sunitinib as an adjuvant treatment for resected renal cell carcinoma. The other authors declare no competing interests.
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Porta, C., Cosmai, L., Leibovich, B.C. et al. The adjuvant treatment of kidney cancer: a multidisciplinary outlook. Nat Rev Nephrol 15, 423–433 (2019). https://doi.org/10.1038/s41581-019-0131-x
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DOI: https://doi.org/10.1038/s41581-019-0131-x