Department of Medicine, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Curr Opin Urol. 2019 Nov;29(6):636-642. doi: 10.1097/MOU.0000000000000666.
Here we explore the recent and relevant trials for treatment of renal cell cancer (RCC) in the adjuvant and neoadjuvant settings as well as recent updates to the guidelines for RCC management.
Most phase III studies of tyrosine kinase inhibitors in the adjuvant setting have been negative. Notably, sunitinib received regulatory approval by the FDA after showing improved disease-free survival in high risk populations. Recent improvements in the genetic classification and understanding of RCC molecular and genetic disorder will hopefully improve patient selection. Meanwhile, recent advances in metastatic RCC treatment, particularly with the combination of tyrosine kinase inhibitors and immune checkpoint inhibitors, have given rise to hope that advances can be made by moving these treatment strategies forward to the adjuvant or neoadjuvant settings.
In the absence of a clinical trial, observation remains the standard of care. Based on the S-TRAC data, sunitinib is approved for use in the adjuvant setting, and can be considered under select circumstances. Although there is optimism for checkpoint monotherapy and combination therapy in the adjuvant or neoadjuvant setting, ongoing studies will determine clinical benefit and tolerability in this setting. Therefore, for patients with high risk of recurrent disease clinical trials of checkpoint inhibitor therapy are viable options.
本文探讨了肾细胞癌（RCC）辅助和新辅助治疗的最新相关试验，以及 RCC 管理指南的最新更新。
辅助治疗中酪氨酸激酶抑制剂的大多数 III 期研究均为阴性。值得注意的是，舒尼替尼在高危人群中显示出改善无病生存期后，获得了 FDA 的监管批准。最近在 RCC 的遗传分类和分子遗传学障碍方面的进展有望改善患者选择。同时，转移性 RCC 治疗的最新进展，特别是酪氨酸激酶抑制剂和免疫检查点抑制剂的联合应用，使人们希望能够将这些治疗策略推进到辅助或新辅助治疗中。
在缺乏临床试验的情况下，观察仍然是标准治疗方法。根据 S-TRAC 数据，舒尼替尼被批准用于辅助治疗，在某些情况下可以考虑使用。尽管在辅助或新辅助治疗中，检查点单药治疗和联合治疗有一定的前景，但正在进行的研究将确定该治疗方案的临床获益和耐受性。因此，对于有复发风险的患者，检查点抑制剂治疗的临床试验是可行的选择。
