Neoadjuvant Approaches for Renal Cell Carcinoma

Naomi Haas, MD, from the Hospital at the University of Pennsylvania, explains that most trials regarding neoadjuvant therapy for renal cell carcinoma (RCC) have been small-scale. However, these studies have successfully demonstrated that neoadjuvant treatment is both safe and feasible for patients.

The only phase 3 trial to date involving a neoadjuvant component is the PROSPER trial, which unfortunately did not show a clear benefit. This trial utilized a hybrid design where patients received one or two doses of nivolumab before undergoing nephrectomy, followed by nine months of adjuvant nivolumab. In contrast, the control group proceeded directly to surgery with subsequent observation. Due to this design, the specific impact of the neoadjuvant portion of the treatment remains unclear.

Dr Haas emphasizes that her primary consideration for neoadjuvant therapy involves patients with unresectable disease who already require systemic therapy. In cases where patients show a positive response to systemic treatment, the possibility of performing surgery is reconsidered. This approach offers a potential pathway to surgery for those whose condition might otherwise be deemed inoperable, highlighting the evolving role of neoadjuvant options in managing advanced RCC.