TY - JOUR
T1 - The 2022 Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitor Therapy for Renal Cell Carcinoma
AU - Bedke, Jens
AU - Albiges, Laurence
AU - Capitanio, Umberto
AU - Giles, Rachel H.
AU - Hora, Milan
AU - Ljungberg, Börje
AU - Marconi, Lorenzo
AU - Klatte, Tobias
AU - Volpe, Alessandro
AU - Abu-Ghanem, Yasmin
AU - Dabestani, Saeed
AU - Fernández-Pello, Sergio
AU - Hofmann, Fabian
AU - Kuusk, Teele
AU - Tahbaz, Rana
AU - Powles, Thomas
AU - Bex, Axel
N1 - Publisher Copyright:
© 2022 European Association of Urology
PY - 2023/1/1
Y1 - 2023/1/1
N2 - In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the trial until final overall survival data and results from other trials were available. Meanwhile, the primary DFS endpoints were not met for adjuvant atezolizumab (PD-L1 inhibitor; IMmotion010), adjuvant nivolumab plus ipilimumab (CheckMate 914), or perioperative nivolumab (PROSPER). Owing to heterogeneity, a meta-analysis is not recommended. Pembrolizumab remains the only immune checkpoint inhibitor currently recommended in this setting. Overall survival data are immature and biomarkers to predict outcome are lacking. Uncertainty exists and overtreatment is occurring. Treatment decisions should be made with caution and with the involvement of each patient. Patient summary: New results from three trials of immunotherapy after surgery for kidney cancer to reduce the risk of recurrence showed no improvement with these treatments. These results are in contrast to an earlier study that showed that the antibody pembrolizumab did extend the time before kidney cancer recurrence, even though it is not yet clear if overall survival is longer. Thus, we cautiously recommend pembrolizumab as additional treatment in high-risk kidney cancer after surgery, but patient preference should be carefully considered and the risk of overtreatment should be discussed.
AB - In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the trial until final overall survival data and results from other trials were available. Meanwhile, the primary DFS endpoints were not met for adjuvant atezolizumab (PD-L1 inhibitor; IMmotion010), adjuvant nivolumab plus ipilimumab (CheckMate 914), or perioperative nivolumab (PROSPER). Owing to heterogeneity, a meta-analysis is not recommended. Pembrolizumab remains the only immune checkpoint inhibitor currently recommended in this setting. Overall survival data are immature and biomarkers to predict outcome are lacking. Uncertainty exists and overtreatment is occurring. Treatment decisions should be made with caution and with the involvement of each patient. Patient summary: New results from three trials of immunotherapy after surgery for kidney cancer to reduce the risk of recurrence showed no improvement with these treatments. These results are in contrast to an earlier study that showed that the antibody pembrolizumab did extend the time before kidney cancer recurrence, even though it is not yet clear if overall survival is longer. Thus, we cautiously recommend pembrolizumab as additional treatment in high-risk kidney cancer after surgery, but patient preference should be carefully considered and the risk of overtreatment should be discussed.
KW - Adjuvant
KW - Clear cell
KW - High risk
KW - Metastasectomy
KW - Pembrolizumab
KW - Renal cell carcinoma
KW - Tyrosine kinase inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85140624777&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2022.10.010
DO - 10.1016/j.eururo.2022.10.010
M3 - Article
C2 - 36511268
AN - SCOPUS:85140624777
SN - 0302-2838
VL - 83
SP - 10
EP - 14
JO - European Urology
JF - European Urology
IS - 1
ER -