Next Steps for Finding Optimal Role for Adjuvant RCC Therapy

Eric A. Singer, MD, MS, chief of the Division of Urologic Oncology, director of the Urologic Oncology Fellowship Program, and co-director of the Genitourinary Disease-Specific Research Group at the Ohio State University Comprehensive Cancer Center, and professor in the Department of Urology, Division of Bioethics at the Ohio State University College of Medicine, discusses future developments that could improve the utilization of adjuvant therapy for high-risk renal cell carcinoma (RCC).

Singer says that investigators are still reviewing the use of drugs like sunitinib (Sutent) and pembrolizumab (Keytruda) as adjuvant therapies to see which drugs provide the most benefit and whether a combination approach would help, though avoiding toxicities is essential.

Refining which patients are at the highest risk of recurrence would help guide who should receive adjuvant therapy after resection, according to Singer. Determining which subsets of patients with stage III disease have the greatest risk could be done through analysis of molecular signatures.

Additionally, more research is needed on how to assess the toxicities of adjuvant systemic therapy. Predicting which patients will have serious adverse events (AEs) could be a factor in deciding whether to use adjuvant therapy. Singer says there may be a set of factors to balance risk of recurrent disease vs risk of severe toxicities to determine on an individual level which patients should be treated.

TRANSCRIPTION:

0:08 | In terms of next steps, I think we're still looking at what's the best drug or drugs, really looking at combination therapy, refining who is going to be truly at highest risk—so really differentiating [between] different ways to be stage III, which of those ways are the ones we really want to focus on? Are there ways that we can better predict through molecular or circulating tumor DNA signatures to get a better sense of who's at highest risk of recurrence?

0:44| And then, like we talked about earlier, not only is this going to make patients live longer, but what are the toxicities associated with it? Can we predict which patients are at especially high risk of the rare but serious AEs? So that may end up with a balancing or a nomogram where we say, OK, here's your risk of recurrence. Here's your risk of severe AEs. How do we put those 2 things into context to make a personalized recommendation on what's going to be the best path forward for you as an individual?