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Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitors and Subsequent Therapy for Renal Cell Carcinoma
J. Bedke, YA. Ghanem, L. Albiges, S. Bonn, R. Campi, U. Capitanio, S. Dabestani, M. Hora, T. Klatte, T. Kuusk, L. Lund, L. Marconi, C. Palumbo, G. Pignot, T. Powles, M. Tran, A. Volpe, A. Bex
Jazyk angličtina Země Švýcarsko
Typ dokumentu časopisecké články, směrnice pro lékařskou praxi, úvodníky
- MeSH
- adjuvantní chemoterapie MeSH
- humanizované monoklonální protilátky MeSH
- inhibitory kontrolních bodů * terapeutické užití škodlivé účinky MeSH
- karcinom z renálních buněk * farmakoterapie MeSH
- lidé MeSH
- nádory ledvin * farmakoterapie patologie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- urologie normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
- úvodníky MeSH
- Geografické názvy
- Evropa MeSH
The KEYNOTE-564 trial showed that adjuvant immune checkpoint inhibitor (ICI) therapy with pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) and overall (OS) survival in localised clear-cell renal cell carcinoma (RCC) with a high risk of relapse. The TiNivo and CONTACT-03 trials have reported results for subsequent therapy after progression on ICI therapy in the metastatic setting. The European Association of Urology (EAU) RCC guidelines panel reassessed the new trial results to update recommendations for adjuvant therapy and post-adjuvant therapy. Adjuvant pembrolizumab significantly improved OS (hazard ratio 0.62, 95% confidence interval 0.44-0.87; p = 0.005). Recent trials of subsequent ICI after recurrence on ICI in the metastatic setting do not support ICI monotherapy or combination therapy in patients with recurrence on or after adjuvant ICI therapy. There are no prospective trial results for treatment after adjuvant pembrolizumab failure. On the basis of the recent results, the EAU RCC guidelines panel has updated the recommendation for adjuvant therapy and now issues a strong recommendation for adjuvant pembrolizumab. ICI monotherapy or combination therapy is not recommended in patients with recurrence during or shortly after adjuvant pembrolizumab. PATIENT SUMMARY: Treatment with an immunotherapy drug called pembrolizumab after surgery in patients with intermediate-risk or high-risk kidney cancer delays the time to recurrence of cancer and prolongs survival. Therefore, pembrolizumab after surgery is strongly recommended for these patients. However, a significant proportion of patients have life-changing or serious side effects and these must be discussed.
Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
Department of Cancer Medicine Gustave Roussy Université Paris Saclay Villejuif France
Department of Experimental and Clinical Medicine University of Florence Florence Italy
Department of Translational Medicine Division of Urological Cancers Lund University Malmö Sweden
Department of Urology Addenbrookes Hospital Cambridge UK
Department of Urology Chaim Sheba Medical Center Tel Hashomer Ramat Gan Israel
Department of Urology Charité Universitätsmedizin Berlin Berlin Germany
Department of Urology Coimbra University Hospital Coimbra Portugal
Department of Urology Institut Paoli Calmettes Marseille France
Department of Urology San Raffaele Scientific Institute Milan Italy
Department of Urology University of Eastern Piedmont Maggiore della Carità Hospital Novara Italy
Division of Cardiology Department of Medicine Karolinska Institutet Stockholm Sweden
Division of Surgery and Interventional Sciences University College London London UK
Karolinska University Hospital Stockholm Sweden
Royal Free London NHS Trust and Barts Cancer Institute Queen Mary University of London London UK
Specialist Centre for Kidney Cancer Royal Free Hospital London UK
The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands
Citace poskytuje Crossref.org
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- $a The KEYNOTE-564 trial showed that adjuvant immune checkpoint inhibitor (ICI) therapy with pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) and overall (OS) survival in localised clear-cell renal cell carcinoma (RCC) with a high risk of relapse. The TiNivo and CONTACT-03 trials have reported results for subsequent therapy after progression on ICI therapy in the metastatic setting. The European Association of Urology (EAU) RCC guidelines panel reassessed the new trial results to update recommendations for adjuvant therapy and post-adjuvant therapy. Adjuvant pembrolizumab significantly improved OS (hazard ratio 0.62, 95% confidence interval 0.44-0.87; p = 0.005). Recent trials of subsequent ICI after recurrence on ICI in the metastatic setting do not support ICI monotherapy or combination therapy in patients with recurrence on or after adjuvant ICI therapy. There are no prospective trial results for treatment after adjuvant pembrolizumab failure. On the basis of the recent results, the EAU RCC guidelines panel has updated the recommendation for adjuvant therapy and now issues a strong recommendation for adjuvant pembrolizumab. ICI monotherapy or combination therapy is not recommended in patients with recurrence during or shortly after adjuvant pembrolizumab. PATIENT SUMMARY: Treatment with an immunotherapy drug called pembrolizumab after surgery in patients with intermediate-risk or high-risk kidney cancer delays the time to recurrence of cancer and prolongs survival. Therefore, pembrolizumab after surgery is strongly recommended for these patients. However, a significant proportion of patients have life-changing or serious side effects and these must be discussed.
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