Dr Yekedüz on a Case Study of Adjuvant Treatment Options in ccRCC

Emre Yekedüz, MD, research fellow, Dana-Farber Cancer Institute, discusses a case study shared via social mediathat evaluated treatment options for a patient with clear cell renal cell carcinoma (ccRCC).

In a social media poll to members of the oncology community, which was posted to X (previously Twitter), Yekedüz highlighted a case study that prompted conversations about the applicability of different RCC management avenues.Notably, this was done to raise awareness for World Kidney Cancer Day, which took place on June 20, 2024. The poll read: “[A] 62-year-old man underwent radical nephrectomy for a 75-mm left renal mass diagnosed as ccRCC with sarcomatoid features. [The] tumor invaded perirenal sinus fat but did not [extend] beyond Gerota’s fascia, with clear surgical margins. Imaging revealed no distant metastases. What’s [the] next step?”

The patient in the case was diagnosed with pathological T3 and grade 4 ccRCC with sarcomatoid features, Yekedüz begins. The key question posed by the poll was about the next step for adjuvant treatment for this patient with ccRCC, he reports.

According to the poll results, 69% of responders selected adjuvant pembrolizumab (Keytruda) as the preferred treatment option, Yekedüz explains. This outcome is not unexpected given that the phase 3 KEYNOTE-564 trial (NCT03142334) was the first to demonstrate improved overall survival with pembrolizumab vs placebo in the adjuvant setting in patients with kidney cancer, he says. Prior to these findings, TKIs had not been successful agents for treating patients with early-stage kidney cancer in the adjuvant setting, making the KEYNOTE-564 trial a significant milestone, Yekedüz notes.

The National Comprehensive Cancer Network Guidelines suggest that pembrolizumab should be the first adjuvanttreatment consideration for patients with ccRCC based on KEYNOTE-564 data. However, it’s important to consider individual patient factors, such as preexisting autoimmune diseases, which may increase the risk of immune-related adverse effects during pembrolizumab treatment, he emphasizes. These conditions must be carefully evaluated before initiating therapy, highlighting the importance of personalized treatment approaches in clinical practice, Yekedüz concludes.