A study published in the European Urology Oncology reports superior oncologic and safety benefits of adjuvant pembrolizumab compared with adjuvant tyrosine kinase inhibitors (TKIs) in patients treated with nephrectomy for localized or locally advanced renal cell carcinoma (RCC). “Pembrolizumab should be considered as a potential standard of care in the adjuvant setting for post-nephrectomy patients with RCC who are at very high risk for disease relapse,” wrote Ekaterina Laukhtina, MD, PhD-candidate, and colleagues.
For the paper, Dr. Laukhtina and colleagues conducted network meta-analyses for disease-free survival (DFS), overall survival (OS), and adverse events (AEs) with placebo as the common comparator arm. Six trials (KEYNOTE-564, S-TRAC, ASSURE, PROTECT, ATLAS, and SORCE) involving 7,525 patients were included. “Given the lack of data on risk/benefit comparison of immune checkpoint inhibitors (ICIs) and TKIs in adjuvant RCC, the primary aim of this systematic review and network meta-analysis was to determine the oncologic and toxicity outcomes of adjuvant pembrolizumab and compare them to those of adjuvant TKIs in the post-nephrectomy setting for patients with nonmetastatic RCC,” the study team wrote.
Significantly Linked With Better Disease-Free Survival
Compared with placebo, both pembrolizumab (HR, 0.68; 95% CI, 0.51–0.92) and pazopanib 800 mg (HR, 0.69; 95% CI, 0.49-0.97) were significantly associated with better DFS. Adjuvant pembrolizumab (HR, 0.54; 95% CI, 0.30-0.97) was significantly associated with better OS compared with TKIs (HR, 0.93; 95% CI, 0.83-1.04). Analysis of treatment ranking revealed that pembrolizumab was the best treatment regarding both DFS and OS and had the lowest likelihood of any-grade and high-grade AEs in comparison with TKIs.
“For patients with kidney cancer at high risk for relapse after surgical removal of their kidney, postoperative therapy with the immune checkpoint inhibitor pembrolizumab offers the best risk/benefit ratio,” the study authors wrote, adding that identification of patients most likely to benefit from adjuvant pembrolizumab and the ideal length of this therapy require further investigation.
