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The effect of adjuvant treatments on the risk of developing metastases after nephrectomy in patients with localized kidney cancer based on trials in 2022 Volume 9, issue 2, March-April 2023

Authors
Oncologie médicale CHU de Tours 2, boulevard Tonnellé 37044 Tours Cedex 09 France. <carneiro.florian@gmail.com> <c.leger@chu-tours.fr> <r.ing@chu-tours.fr> <claude.linassier@univ-tours.fr> <m.cancel@chu-tours.fr>
* Tirés à part : F. Carneiro
Remerciements et autres mentionsFinancement : aucun.Liens d’intérêts : les auteurs déclarent ne pas avoir de lien d’intérêt.

Twenty percent (20%) of patients with localized kidney cancer will develop metastases after nephrectomy. Several randomized trials have tested the benefit of adjuvant treatment with a tyrosine kinase inhibitor (TKI) or an immune checkpoint inhibitor (ICI) versus placebo in reducing the risk of recurrence. Among the five trials that evaluated the benefit of a TKI with anti-VEGFR activity, only the S-TRAC trial, offering oral treatment with sunitinib for one year, significantly improved the duration of disease-free survival by approximately one year despite significant toxicity. Among the immunotherapies, one-year treatment with pembrolizumab (KEYNOTE-564 trial) significantly increased the duration of disease-free survival and overall survival. However, none of the two other randomized trials exploring the preventive effect of an ICI versus placebo revealed a benefit regarding disease-free survival: IMmotion010 (atezolizumab) and CheckMate 914 (nivolumab + ipilimumab combination). Several factors are likely to explain these divergent results, such as the absence of an unequivocal definition of patients at “high risk of recurrence”, compliance, or the intrinsic activity of the molecules used. A better definition of patients at high risk of recurrence is therefore essential.