Dr. McGregor on Advances Made in the Adjuvant Setting of RCC

Bradley McGregor, MD, clinical director, Lank Center for Genitourinary Oncology, senior physician, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses advances made in the adjuvant setting of renal cell carcinoma (RCC).

Four trials have investigated the use of TKIs in the adjuvant setting, including the ASSURE trial comparing sunitinib (Sutent) with sorafenib (Nexavar), which showed no difference in progression-free survival (PFS) or overall survival (OS). Additionally, there was the ATLAS trial, which looked at axitinib (Inlyta) versus placebo, and showed no difference in PFS or OS. Data from the PROTECT trial with pazopanib (Votrient) showed no difference in OS or PFS. However, the S-TRAC trial, which looked at very high-risk patients, showed that 1 year of sunitinib resulted in an improvement in disease-free survival. However, no benefit in OS has been reported yet, says McGregor. Even so, this may be a suitable option for patients who are able to tolerate its side effect profile, he adds.

The PROSPER trial is a perioperative study of nivolumab (Opdivo), in which patients receive neoadjuvant nivolumab followed by adjuvant nivolumab versus observation. There are also localized trials looking at pembrolizumab (Keytruda) versus placebo and atezolizumab (Tecentriq) versus placebo. Since these are placebo-controlled trials, counseling patients on whether or not to enroll should be a nuanced discussion, says McGregor.