What is the role of molecular therapy in the treatment of early-stage renal cell carcinoma (RCC)?

Updated: May 21, 2019
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
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Answer

For early-stage RCC, an emerging treatment strategy is to utilize molecular approaches earlier in the adjuvant setting in order to improve overall survival rates. However, interim analysis of a randomized phase 3 trial of sunitinib versus sorafenib versus placebo as adjuvant therapy in patients with resected renal cell carcinoma showed no difference in disease-free or overall survival. The investigators concluded that  patients with locally advanced resected renal cell carcinoma should not be given adjuvant treatment. [63]

In contrast, another study by S-TRAC investigators demonstrated that patients at high risk for tumor recurrence after nephrectomy may benefit from adjuvant therapy with sunitinib. The median duration of disease-free survival was significantly longer in those who took 50 mg of sunitinib daily for 4 weeks on/2 weeks off schedule for 1 year following nephrectomy. Suvival data was not mature at the time of analysis for this study. [64]

For patients with stage II or III RCC who have undergone nephrectomy (radical or partial), NCCN recommendations for adjuvant therapy in those with clear cell histology and high-risk features include sunitinib as a category 2B option. However, the NCCN's preferred strategy in those cases is participation in a clinical trial. Surveillance is also an option.20


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