Adjuvant therapy for renal cell carcinoma

2023 Canadian Kidney Cancer Forum consensus statement

Authors

  • Aly-Khan A. Lalani Juravinski Cancer Centre
  • Anil Kapoor St. Joseph's Healthcare Hamilton
  • Naveen S. Basappa Cross Cancer Institute
  • Bimal Bhindi Southern Alberta Institute of Urology
  • Georg A. Bjarnason Odette Cancer Centre, Sunnybrook Health Sciences Centre
  • Dominick Bosse University of Ottawa
  • Rodney H. Breau University of Ottawa
  • Christina M. Canil University of Ottawa
  • Luisa M. Cardenas Juravinski Cancer Centre
  • Vincent Castonguay Centre de recherche du Centre Hospitalier Universitaire de Québec – Université Laval
  • Claudia Chavez-Munoz Vancouver Prostate Centre
  • William Chu Odette Cancer Centre, Sunnybrook Health Sciences Centre
  • Shaan Dudani William Osler Health System, Brampton
  • Jeffrey Graham University of Manitoba
  • Daniel Y.C. Heng Department of Medical Oncology, Tom Baker Cancer Center
  • Christian Kollmannsberger BC Cancer - Vancouver Centre
  • Jean-Baptiste Lattouf University of Montreal
  • Scott Morgan Ottawa Hospital Research Institute
  • M. Neil Reaume University of Ottawa
  • Patrick O. Richard Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS
  • Anand Swaminath Juravinski Cancer Centre
  • Simon Tanguay McGill University
  • Lori A. Wood Dalhousie University
  • Luke T. Lavallée University of Ottawa

DOI:

https://doi.org/10.5489/cuaj.8381

Keywords:

renal cell carcinoma, adjuvant therapy, immunotherapy

Abstract

INTRODUCTION: Several recent randomized trials evaluated the impact of adjuvant immune checkpoint inhibitor (ICI)-based therapy on post-surgical outcomes in renal cell carcinoma (RCC), with disparate results. The objective of this consensus statement is to provide data-driven guidance regarding the use of ICIs after complete resection of clear-cell RCC in a Canadian context.

METHODS: An expert panel of genitourinary medical oncologists, urologic oncologists, and radiation oncologists with expertise in RCC management was convened in a dedicated session during the 2022 Canadian Kidney Cancer Forum in Toronto, Canada. Topic statements on the management of patients after surgery for RCC, including counselling, risk stratification, indications for medical oncology referral, appropriate followup, eligibility and management for adjuvant ICIs, as well as treatment options for patients with recurrence who receive dadjuvant immunotherapy, were discussed. Participants were asked to vote if they agreed or disagreed with each statement. Consensus was achieved if greater than 75% of participants agreed with the topic statement.

RESULTS: A total of 22 RCC experts voted on 14 statements. Consensus was achieved on all topic statements. The panel felt patients with clear-cell RCC at increased risk of recurrence after surgery, as per the Keynote-564 group definitions, should be counselled about recurrence risk by a urologist, should be informed about the potential role of adjuvant ICI systemic therapy, and be offered referral to discuss risks and benefits with a medical oncologist. The panel felt that one year of pembrolizumab is currently the only regimen that should be considered if adjuvant therapy is selected. Panelists emphasized current opinions are based on disease-free survival given the available results. Significant uncertainty regarding the benefit and harms of adjuvant therapy remains, primarily due to a lack of consistent benefit observed across similar trials of adjuvant ICI-based therapies and immature overall survival (OS) data.

CONCLUSIONS: This consensus document provides guidance from Canadian RCC experts regarding the potential role of ICI-based adjuvant systemic therapy after surgery. This rapidly evolving field requires frequent evidence-based re-evaluation.

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Published

2023-04-25

How to Cite

Lalani, A.-K. A. ., Kapoor, A., Basappa, N. S. ., Bhindi, B. ., Bjarnason, G. A. ., Bosse, D. ., Breau, R. H. ., Canil, C. M. ., Cardenas, L. M. ., Castonguay, V. ., Chavez-Munoz, C. ., Chu, W., Dudani, S. ., Graham, J. ., Heng, D. Y. ., Kollmannsberger, C. ., Lattouf, J.-B. ., Morgan, S. ., Reaume, M. N., Richard, P. O. ., Swaminath, A. ., Tanguay, S. ., Wood, L. A. ., & Lavallée, L. T. . (2023). Adjuvant therapy for renal cell carcinoma: 2023 Canadian Kidney Cancer Forum consensus statement . Canadian Urological Association Journal, 17(5), E154–63. https://doi.org/10.5489/cuaj.8381

Issue

Vol. 17 No. 5 (2023): CUAJ May

Section

Consensus Statement

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