Dr Pal on Future Research Directions With Adjuvant Immunotherapy in High-Risk Resected RCC

“We are looking to conduct trials that enrich for patients who truly need adjuvant therapy. The data that we have produced offer a suggestion that down the line we can do trials that are focused in these subsets of individuals who we [believe are] at the highest risk for recurrence.”

Sumanta Kumar Pal, MD, FASCO, chair of the Kidney and Bladder Cancer Disease Team, co-director of the Kidney Cancer Program, and a professor and vice chair of Academic Affairs in the Department of Medical Oncology & Therapeutics Research at City of Hope, discussed future directions using genomic data from the phase 3 IMmotion010 trial (NCT03024996).

During the 2025 ASCO Annual Meeting, Pal presented data from a genomic analysis of IMmotion010, which evaluated adjuvant atezolizumab (Tencentriq) vsplacebo in patients with high-risk localized renal cell carcinoma (RCC). Although primary findings from IMmotion010 showed that adjuvant atezolizumab did not prolong disease-free survival (DFS) vs placebo, data from the genomic analysis demonstrated that patients with certain molecular characteristics experienced a benefit with the agent.

Specifically, patients with high KIM-1 expression who received adjuvant atezolizumab (n = 151) achieved a median DFS that was not estimable (NE) compared with 21.16 months in the placebo arm (n = 149; HR, 0.72; 95% CI, 0.52-0.99). Comparatively, patients with low KIM-1 expression in the atezolizumab (n = 229) and placebo (n = 223) arms experienced a median DFS of 57.23 months and NE, respectively (HR, 1.12; 95% CI, 0.88-1.63).

In the future, investigators can use these data to design clinical trials that enrich for patient subgroups who will benefit from adjuvant therapy, Pal said. This includes creating future trials that are focused on patients with KIM-1–high or T-effector–high disease, he added. According to data from the genomic analysis, these patient subsets are at the highest risk of disease recurrence and would benefit the most from adjuvant therapy, he noted. Overall, the data collected by Pal and his coauthors will be useful in terms of tailoring therapy for patients, he concluded.