AI Article Synopsis

  • Many patients with non-metastatic renal cell carcinoma can be cured with surgery, but over 40% may experience a recurrence, prompting interest in additional treatments.
  • Previous adjuvant systemic therapies, particularly antiangiogenic tyrosine kinase inhibitors (TKIs), have shown limited effectiveness and significant side effects, leading to exploration of alternative strategies like immune checkpoint inhibitors (ICIs).
  • The review evaluates the strengths and weaknesses of existing TKI trials, discusses reasons for their failures, and highlights ongoing clinical trials to optimize perioperative treatment approaches for improving outcomes in non-metastatic RCC.

Article Abstract

While many patients with non-metastatic renal cell carcinoma (RCC) can be cured with surgery alone, upward of 40% of patients recur in a short delay, raising the question of additional perioperative treatments. To address this clinical need, multiple trials have investigated the addition of systemic therapy after surgery in localized or locally advanced RCC. However, adjuvant systemic therapies in the past decades have provided disappointing results with only one positive study of antiangiogenic treatments. Debatable clinical benefit of adjuvant antiangiogenic tyrosine kinase inhibitors (TKIs) therapy at cost of high adverse event profiles have paved the way for development of alternative perioperative strategies, such as immune checkpoint inhibitors (ICIs). Further investigation into combination therapies with immunotherapy, neoadjuvant approaches and patient selection will be key to determining optimal adjuvant therapy regimens to improve outcomes and increase cure rates for patients with non-metastatic RCC. In this review, we extensively present the strong and weakness of the five adjuvant antiangiogenic TKI trials, highlight the main differences and discuss about the reasons of failure. We also expose the current ongoing clinical trials in the perioperative setting and provide new insights concerning the evolving landscape of the management of non-metastatic RCC.

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http://dx.doi.org/10.1016/j.ctrv.2021.102207DOI Listing

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