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Adjuvant Treatment and Follow-Up of Clinically Localized Renal Cell Carcinoma

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A Guide to Management of Urological Cancers

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Abstract

High-grade/stage clinically localized renal cell carcinoma (RCC) is associated with a significant risk of recurrence following definitive surgical therapy. Various models have been developed to predict the risk of postoperative recurrence based on clinical and pathologic features of the primary tumor. Novel gene-based signatures have also been investigated to further improve these predictive nomograms. Patients at high risk of recurrence may be offered adjuvant systemic therapy with the goal of eradicating micro-metastatic disease, preventing recurrence, and improving survival. To date, systemic-targeted therapies against angiogenesis pathways such as vascular endothelial growth factor (VEGF) and tyrosine kinase inhibitor(s) (TKI) have failed to demonstrate a significant impact on overall survival (OS). Given the effective and durable antitumor activity associated with novel immunotherapies in metastatic RCC, immune checkpoint inhibitor(s) (ICI) are being investigated in the adjuvant setting. This chapter provides a comprehensive summary on clinical-risk prediction models in high-risk localized RCC and insight into clinical trials of systemic therapies in the adjuvant space.

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Abbreviations

AE:

Adverse events

ccRCC:

Clear cell renal cell carcinoma

CSS:

Cancer-specific survival

DFS:

Disease-free survival

ECOG:

Eastern Cooperative Oncology Group

HR:

High risk

ICI:

Immune checkpoint inhibitor(s)

IR:

Intermediate risk

ITT:

Intention to treat

LR:

Low risk

MAMs:

Multiarm multistage

MSK:

Memorial Sloan Kettering

OS:

Overall survival

PDGF:

Platelet-derived growth factor

RCC:

Renal cell carcinoma

SSIGN:

The stage, size, grade, and necrosis

TCGA:

The cancer genome atlas

TKI:

Tyrosine kinase inhibitor(s)

UISS:

University of California Los Angeles Integrated Staging System

VEGF:

Vascular endothelial growth factor

VHL:

Von Hippel-Lindau

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Acknowledgments

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Disclosures

Rudzinski JK1, Beech BB2, Wang B3, and Zemp LW5 have no conflicts or disclosures. Sonpavde GP4 has following conflicts & disclosures in the past 36 months:

  1. 1.

    Advisory Board: BMS, Genentech, EMD Serono, Merck, Sanofi, Seattle Genetics/Astellas, Astrazeneca, Exelixis, Janssen, Bicycle Therapeutics, Pfizer, Gilead, Scholar Rock, G1 Therapeutics, Eli Lilly/Loxo Oncology, Infinity Pharmaceuticals

  2. 2.

    Research Support: Sanofi, Astrazeneca, Gilead, QED, Lucence, Predicine, BMS, EMD Serono

  3. 3.

    Steering committee of studies: BMS, Bavarian Nordic, Seattle Genetics, QED, G1 Therapeutics (all unpaid), and Astrazeneca, EMD Serono, Debiopharm (paid)

  4. 4.

    Data safety monitoring committee: Mereo

  5. 5.

    Employment: Spouse employed by Myriad

  6. 6.

    Travel costs: BMS, Astrazeneca.

  7. 7.

    Writing/Editor fees: Uptodate, Editor of Elsevier Practice Update Bladder Cancer Center of Excellence.

  8. 8.

    Speaking fees: Physicians Education Resource (PER), Onclive, Research to Practice, Medscape, Cancer Network, Masters Lecture Series (MLS).

Conflicts of Interest

None of the authors have any relevant disclosures, and none of the authors have any financial or nonfinancial interests that may be relevant to the submitted work.

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Author notes

  1. Jan K. Rudzinski and Benjamin B. Beech contributed equally with all other contributors.

Authors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jan K. Rudzinski

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Benjamin B. Beech

  3. Faculty of Medicine and Dentistry, Division of Urology, University of Alberta, Edmonton, AB, Canada

    Betty Wang

  4. Dana-Farber Cancer Institute, Genitourinary Cancer Section, Boston, MA, USA

    Guru Sonpavde

  5. Department of Genitourinary Oncology, Moffit Cancer Center, Tampa, FL, USA

    Logan W. Zemp

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Correspondence to Logan W. Zemp .

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Editors and Affiliations

  1. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Prabhjot Singh

  2. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Brusabhanu Nayak

  3. Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Sridhar Panaiyadiyan

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Rudzinski, J.K., Beech, B.B., Wang, B., Sonpavde, G., Zemp, L.W. (2023). Adjuvant Treatment and Follow-Up of Clinically Localized Renal Cell Carcinoma. In: Singh, P., Nayak, B., Panaiyadiyan, S. (eds) A Guide to Management of Urological Cancers. Springer, Singapore. https://doi.org/10.1007/978-981-99-2341-0_5

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