Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitors and Subsequent Therapy for Renal Cell Carcinoma
(2025) In European Urology 87(4). p.491-496- Abstract
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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2025-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adjuvant therapy, Clear cell histology, High risk, Metastasectomy, Overall survival, Pembrolizumab, Renal cell carcinoma, Tyrosine kinase inhibitor
- in
- European Urology
- volume
- 87
- issue
- 4
- pages
- 6 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:39904712
- scopus:85216789448
- ISSN
- 0302-2838
- DOI
- 10.1016/j.eururo.2025.01.014
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 European Association of Urology
- id
- 5feb3ba0-0274-460c-a4fa-e5dc70e22009
- date added to LUP
- 2025-04-11 10:38:03
- date last changed
- 2025-07-04 17:35:45
@article{5feb3ba0-0274-460c-a4fa-e5dc70e22009,
abstract = {{<p>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.</p>}},
author = {{Bedke, Jens and Ghanem, Yasmin Abu and Albiges, Laurence and Bonn, Stephanie and Campi, Riccardo and Capitanio, Umberto and Dabestani, Saeed and Hora, Milan and Klatte, Tobias and Kuusk, Teele and Lund, Lars and Marconi, Lorenzo and Palumbo, Carlotta and Pignot, Geraldine and Powles, Thomas and Tran, Maxine and Volpe, Alessandro and Bex, Axel}},
issn = {{0302-2838}},
keywords = {{Adjuvant therapy; Clear cell histology; High risk; Metastasectomy; Overall survival; Pembrolizumab; Renal cell carcinoma; Tyrosine kinase inhibitor}},
language = {{eng}},
number = {{4}},
pages = {{491--496}},
publisher = {{Elsevier}},
series = {{European Urology}},
title = {{Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitors and Subsequent Therapy for Renal Cell Carcinoma}},
url = {{http://dx.doi.org/10.1016/j.eururo.2025.01.014}},
doi = {{10.1016/j.eururo.2025.01.014}},
volume = {{87}},
year = {{2025}},
}