What is it about?

This is a meta-analysis of studies examining the use of adjuvant immune checkpoint inhibitors (ICIs) for patients with renal cell carcinoma (RCC). The primary outcome of interest was disease-free survival (DFS). The analysis included four studies, and the results were mixed with considerable heterogeneity between them. The subgroup analysis found that patients with positive PD-L1 expression or sarcomatoid features benefited most from adjuvant immunotherapy. The recent positive results of KEYNOTE-564 led to the approval of pembrolizumab by the FDA. Current guidelines have a weak recommendation for the use of adjuvant pembrolizumab in high-risk ccRCC. Further research is needed to determine the overall benefit of adjuvant ICIs in RCC.

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Why is it important?

This research is important as it synthesizes available data regarding the disease-free survival (DFS) benefit of adjuvant immune checkpoint inhibitors (ICIs) for patients with renal cell carcinoma (RCC) and evaluates the overall safety profile of ICIs in this setting. The study identifies the subgroup of patients who are most likely to benefit from adjuvant immunotherapy, which has significant implications for patient selection and treatment personalization. Key Takeaways: 1. The evidence base to date regarding ICIs as adjuvant therapy in RCC is mixed and conclusions are limited by considerable heterogeneity between studies. 2. Pooled analyses suggest that patients with positive PD-L1 expression or sarcomatoid features are most likely to benefit from adjuvant immunotherapy. 3. Adjuvant pembrolizumab use in RCC remains in the realm of patient and clinician choice, with consideration of individualized potential benefit and risk related to immune-related adverse events (irAEs). 4. Further readout of overall survival (OS) benefit, which hereto remains immature, is needed to make final conclusions.

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This page is a summary of: Adjuvant immunotherapy in renal cell carcinoma: a systematic review and meta‐analysis, BJU International, February 2023, Wiley,
DOI: 10.1111/bju.15981.
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