Dr Tang on Unanswered Questions About the Role of Radiation Therapy in RCC

Chad Tang, MD, associate professor, Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, associate professor, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses unanswered questions surrounding the role of radiation therapy in patients with renal cell carcinoma (RCC).

Ongoing research in this arena is exploring the potential of upfront or sequenced radiation therapy for primary tumors in patients with metastatic disease, Tang begins. Currently, there are at least 3 significant trials of interest investigating this approach, he notes. These include the phase 2 CYTOSHRINK trial (NCT04090710) based in Canada, the phase 2 SAMURAI study (NCT05327686) conducted in the United States, and a newly initiated Italy-based trial called ITALIC-RCC (EudraCT 2024-517789-41-00), he explains. Radiation therapy is of particular interest because it offers the advantage of shorter recovery periods and less interruption of systemic therapy compared with surgical interventions, Tang states.

In addition, there is growing interest in using radiation therapy as an alternative to systemic treatment for patients with indolent, oligometastatic RCC, he expands, adding that the phase 3 SOAR trial (NCT05863351) has recently opened and will randomly assign patients with kidney cancer with limited metastases to receive either a radiation-based strategy or the standard of care, which typically involves systemic therapy. Another area of active investigation is the use of adjuvant radiation therapy in combination with immunotherapy, Tang notes. The phase 2 ASTROs study (NCT06004336), for which Tang serves as the principal investigator, is examining the efficacy of pembrolizumab (Keytruda) administered as adjuvant therapy following radiation for patients with oligometastatic RCC, he explains.

These trials represent exciting opportunities to further understand how radiation therapy can be integrated into RCC management, potentially offering new strategies for managing metastatic disease with fewer effects on systemic treatment schedules and overall patient recovery, Tang concludes.