Adjuvant Therapies in Nonmetastatic Renal-Cell Carcinoma: A Review of the Literature

We conducted a review of the literature to identify all relevant studies about adjuvant therapy in nonmetastatic renal-cell carcinoma. Historical therapies such as interferon a, interleukin 2, vaccines, andmonoclonal antibodies failed to improve disease-free and overall survival. Results from three phase 3 trials on adjuvant therapy with tyrosine kinase inhibitors reported conflicting results. Results from ongoing trials on checkpoint immunotherapy agents are highly anticipated. To conduct a review of literature on adjuvant therapy in nonmetastatic renal-cell carcinoma (nmRCC) treated with nephrectomy and to describe the efficacy of adjuvant agents on cancer control outcomes. A review of the literature was performed in January 2018 to identify all studies evaluating adjuvant therapy in patients with nmRCC treated with nephrectomy using PubMed, Embase, Medline, and Cochrane Library databases. The following keywords were used: adjuvant therapy, renal-cell carcinoma, nonmetastatic, targeted molecular therapy, kidney cancer. The ClinicalTrials. gov website was queried to identify ongoing trials. Traditional adjuvant therapy agents consisted of interferon a, interleukin 2, autologous tumor cell vaccines, and monoclonal antibodies. None provided survival benefit. Three contemporary studies (S-TRAC, ASSURE, and PROTECT) using targeted therapy compared sunitinib to placebo (STRAC), sunitinib or sorafenib to placebo (ASSURE), and pazopanib to placebo (PROTECT), with controversial results. In contrast to ASSURE and PROTECT, S-TRAC demonstrated improved disease-free survival. Several trials that use checkpoint immunotherapy agents or vascular endothelial growth factor receptor tyrosine kinase inhibitors are ongoing. Many traditional therapies have shown no success as adjuvant therapy for nmRCC after nephrectomy. Targeted adjuvant therapy for nmRCC after nephrectomy showed controversial results, and its routine use is not currently endorsed. (C) 2018 Elsevier Inc. All rights reserved.