The 2024 Society of Urologic Oncology (SUO) annual meeting in Dallas featured a presentation by Dr. Naomi Haas on neoadjuvant therapy trials in renal cell carcinoma (RCC). Dr. Haas discussed the outcomes of recently completed trials, emphasizing their safety but noting limited evidence of pathologic response or RECIST partial response. She highlighted several trials exploring combinations of immune checkpoint inhibitors (IO) and targeted therapies (TKIs), IO-IO combinations, and IO monotherapy.
One of the key trials discussed was the PROSPER-RCC study, which enrolled 819 patients randomized to perioperative nivolumab or surgery alone. The trial was stopped early due to futility, with no significant difference in recurrence-free survival (RFS) between the groups. However, a sensitivity analysis showed fewer recurrences in the nivolumab plus surgery group compared to the surgery-only group.
Dr. Haas also mentioned ongoing trials testing different durations of treatment with ICI + VEGFR-TKI combinations, including neoadjuvant lenvatinib + pembrolizumab for patients with IVC thrombus or RCC. These trials aim to determine the optimal duration of therapy and the best combination of treatments.
Additionally, the presentation covered the potential of Kidney Injury Molecule-1 (KIM-1) as a biomarker for RCC, with studies showing that high KIM-1 levels are associated with reduced disease-free survival but may benefit from specific treatments like atezolizumab or nivolumab + ipilimumab.
Dr. Haas concluded with key takeaways, including the safety of perioperative immunotherapy without additional surgical risks, the potential of VEGFR-TKI + IO combinations for tumor shrinkage, and the need for further research to answer remaining questions about the ideal duration and combination of therapies in the neoadjuvant setting.
