Episode 4: Adjuvant Therapy and Post-Surgical Management Options for Kidney Cancer

In the most recent episode of Oncology Decoded, co-hosts Manojkumar Bupathi, MD, MS, executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers; and Benjamin Garmezy, MD, associate director of Genitourinary Research and executive co-chair of Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers, engaged in a detailed discussion focused on adjuvant therapy for kidney cancer, providing key insights regarding available treatment options.

The discussion began with defining adjuvant therapy that aims to improve disease-free survival, overall survival, or both. The hosts explore effective ways to communicate the goals and potential benefits of adjuvant therapy to patients, acknowledging the challenge of recommending treatment to patients who may feel they are already “cured” after surgery.

The conversation transitioned to the specifics of adjuvant therapy in renal cell carcinoma (RCC), with a focus on clear cell RCC. Bupathi and Garmezy discussed the evolution of treatment strategies from VEGF tyrosine kinase inhibitors (TKIs) to immunotherapy. They highlighted the significance of the phase 3 KEYNOTE-564 trial (NCT03142334), which supported the approval of adjuvant pembrolizumab (Keytruda), a PD-1 inhibitor, for certain patients who are high-risk. Additionally, they highlighted other immunotherapy trials and the distinction between PD-1 and PD-L1 inhibitors.

The discussion also touched upon patient selection for adjuvant pembrolizumab, with the hosts sharing their individual approaches. Factors influencing treatment decisions include disease stage, risk of recurrence, patient comorbidities, and potential treatment toxicities. The importance of shared decision-making with patients is emphasized, particularly regarding the balance between potential benefits and risks of treatment.

Finally, practical guidance on managing treatment-related toxicities, including strategies for monitoring patients and addressing potential adverse effects, was mentioned. They also discuss the complexities of monitoring patients’ post-treatment, including the use of

CT scans and the management of pulmonary nodules. The discussion extends to managing progressive disease in patients who have received adjuvant therapy, including the role of VEGF TKIs and clinical trials.