Neoadjuvant and Adjuvant Therapy for Renal Cell Carcinoma
Abstract
Patients undergoing definitive surgery or ablative techniques for nonmetastatic kidney cancer have varying degrees
of risk of recurrent disease post procedure. The ultimate goal of “adjuvant therapy” is to reduce the incidence of
recurrent disease, and to cure more patients. We summarize the current state of perioperative therapy for kidney
cancer and explore future directions to develop optimal adjuvant strategies. We define risk and risk of recurrence
post-definitive therapy, describe the controversies surrounding the trial landscape of adjuvant vascular endothelial
growth factor receptor tyrosine kinase inhibitors and immune checkpoint inhibitors. We review data on neoadjuvant
therapy before advanced kidney cancer resection. Radiologic, ethnic, economic, and geographic considerations
with respect to adjuvant therapy are highlighted, as well as adjuvant therapy issues especially pertinent to patients,
future directions in adjuvant trial design specifically targeted to biomarkers and patient selection, and sequencing of
treatment after adjuvant therapy in those patients with recurrence.
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