In this E-Learning module, by elaborating data from clinical trials, the authors summarise evidence in terms of the current role of surgery for treatment of patients with advanced renal cell carcinoma (RCC), provide an overview of treatment landscape with first-, second-line, and beyond treatment for advanced RCC, as well as an update on adjuvant systemic treatment in patients with clear cell RCC. They also elaborate new agents, new immunotherapies and selected new combinations, thus providing an outlook for future developments in the management of patients with advanced RCC.
The authors state that cytoreductive nephrectomy should no longer be considered standard of care in intermediate- and poor-risk MSKCC groups of metastatic RCC, at least when medical treatment is required. Surgery remains an important modality, preferentially used when patients can have the majority of their disease burden resected (cytoreduction) or rendered free of macroscopic disease (metastasectomy).
In the module, the authors provide a summary of data from phase III trials on adjuvant treatment for in RCC and critically analyse the role of sunitinib or pembrolizumab for adjuvant treatment in patients with clear cell RCC who are at high risk of recurrence.
The authors state that PD-1/L1-based combination regimens with CTLA-4 inhibitors or VEGF tyrosine kinase inhibitors (TKIs) are the standard of care in first-line treatment of advanced clear cell RCC. However, there is no standard of care in the post–immuno-oncology or post-VEGF patient population, resulting in a new therapeutic challenge for clinicians. Choice of second-line systemic treatment depends on the agents(s) used in the frontline setting and use of VEGF TKIs is supported by prospective clinical data and retrospective series.
The authors state that novel agents such as HIF-2α antagonists demonstrate activity in patients pretreated with immune checkpoint inhibitors. Additional combination therapies are under investigation.
