Dr. Margulis on Different Approaches to Adjuvant Therapy in RCC

Vitaly Margulis, MD, assistant professor of Urologic Oncology, UT Southwestern Medical Center, discusses 2 different approaches to administering adjuvant therapy for patients with renal cell carcinoma.

One approach involves the use of a checkpoint inhibitor prior to surgery, followed by surgery, and finally followed by an additional checkpoint inhibitor. This particular strategy can be useful because it allows delivery of the drug with the primary tumor still in place when the antigen load is at its highest, explains Margulis. Thus, the T cells are primed, and then patients can continue their therapy to maintain that response.

However, there is a downside to this approach, says Margulis. Patients will not be able to move onto surgery immediately after the initial administration of the checkpoint inhibitor. Presurgical administration of the drug may delay, or even preclude, some patients from ever going on to receive surgery.

The second approach that Margulis discusses involves a checkpoint inhibitor in a purely adjuvant setting, where the kidney has already been removed. The advantage here, he explains, is that there is no delay in treatment.

Overall, these approaches allow oncologists to examine tissue samples and learn more about how these drugs affect the primary tumor. Moreover, this informs decisions about which patients will benefit from which drugs.