Adjuvant Systemic Therapy After Resection of High-Risk Localized Kidney Cancer - Renal and Urology News

Adjuvant Systemic Therapy After Resection of High-Risk Localized Kidney Cancer

Slideshow

  • Figure 1: Coronal, axial, and sagital cuts from a computed tomography scan demonstrating 6cm lower pole R renal mass R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x in a patient with significant renal insufficiency.

    Slide

    Figure 1: Coronal, axial, and sagital cuts from a computed tomography scan demonstrating 6cm lower pole R renal mass R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x in a patient with significant renal insufficiency.

  • Figure 1: Coronal, axial, and sagital cuts from a computed tomography scan demonstrating 6cm lower pole R renal mass R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x in a patient with significant renal insufficiency.

    Slide

    Figure 1: Coronal, axial, and sagital cuts from a computed tomography scan demonstrating 6cm lower pole R renal mass R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x in a patient with significant renal insufficiency.

  • Slide

    Figure 1: Coronal, axial, and sagital cuts from a computed tomography scan demonstrating 6cm lower pole R renal mass R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x in a patient with significant renal insufficiency.

A 71-year-old man with coronary artery disease and chronic kidney disease stage 3 (GFR 35 mL/min/1.73m2), and thus imperative indications for partial nephrectomy, underwent right transperitoneal robotic partial nephrectomy for 7 cm pT3aN0M0 Grade 3 clear-cell renal cell carcinoma with a R.E.N.A.L. Nephrometry Score of 2+2+3+x+2=9x. 

This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.References1.        Haas NB, Manola J, Uzzo RG et al. Adjuvant sunitinib or sorafenib for high-risk, non metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised,...

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This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.

References

1.        Haas NB, Manola J, Uzzo RG et al. Adjuvant sunitinib or sorafenib for high-risk, non metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial.Lancet 2016;387:2008-2016.

2.        Ravaud A, Motzer RJ, Pandha HS, et al. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med, 2016; published online ahead of print.

Answer: E:

The ASSURE Trial randomized 1943 patients from April 24, 2006, and Sept 1, 2010, to receive sunitinib (647 patients), sorafenib (649 patients), or placebo (647 patients).1  No survival benefit to tyrosine kinase inhibitors was detected in this phase 3 randomized clinical trial. More recently, in the S-TRAC trial, where 615 patients were randomized to receive either placebo or sunitinib for 1 year,2 statistically significant progression-free survival benefit was detected (median progression-free survival 5.6 vs 6.8 yrs). Yet at time of publication, no overall survival benefit was detected. Differences between ASSURE and S-TRAC likely stem from differences in patient baseline risk.  Trials evaluating the role of adjuvant pazopanib (PROTECT) and everolimus (EVEREST) have finished enrollment but have not yet matured. PROTECT results are to be reported in the near future, while EVEREST only recently finished enrollment. Adjuvant PD-1 inhibitor trials are on the horizon but have not yet opened.

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