Urologists Should Make Patients With Metastatic Kidney Cancer Aware that not All Trials Have Positive Results, Says Expert

Patients with kidney cancer should be made aware of trials that have not read out positively in the adjuvant setting, according to an expert from the Royal Free London NHS Foundation Trust.

Not all findings are positive when it comes to trials assessing adjuvant treatments of metastatic kidney cancer, according to Axel Bex, MD, PhD.

Bex, a urologic surgeon at the Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, and a professor at University College London, Division of Surgery and Interventional Science, noted that health care providers must inform their patients that some trials are associated with negative findings.

During the 2022 Society for Urologic Oncology (SUO) Annual Meeting, CancerNetwork® spoke with Bex about his presentation concerning new developments in the adjuvant setting for managing renal cell carcinoma.

Bex also described other key takeaways for community urologists, including how one should not jump to conclusions on data from perioperative trials such as the CheckMate-914 study (NCT03138512), which are “more difficult to perform than…a standard adjuvant study.”


First of all, the most important lesson—we also have patient advocacy members in our guideline panels—is that when you discuss adjuvant therapy, you should actually make the patients aware that there are other trials in the field that have not read out positively. That's the answer. That means that KEYNOTE-564 is a thorough trial, don't get me wrong. It's good that [pembrolizumab] is approved. You have a weak recommendation, but I think it adds to the information for patients. And the other thing I would like colleagues to actually realize is that there's a lot of uncertainty in how we select patients, and that is something we should improve. We should also not jump to conclusions. For example, one might think that nivolumab has been demonstrated to be inefficient by a past trial; that would be shooting over the goal here because we still have the nivolumab monotherapy arm in CheckMate 914, which is partly new. [We should] wait because there may be differences in a perioperative trial, which is more difficult to perform than, for example, a standard adjuvant study.

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