Adjuvant Therapy for High-Risk Renal Cell Carcinoma

The current standard of care for the treatment of patients with high-risk localized or locally advanced renal cell carcinoma is surgical resection alone. Due to the high risk of disease progression and cancer-related death among these patients, there has been considerable interest in exploring adjuvant therapies for use following surgical extirpation. Unfortunately efforts aimed at studying a range of postoperative therapies including cytokine immunotherapy, cancer vaccines, hormonal therapy, and radiation have failed to show a clinical benefit. Additionally, more recent data from two large clinical trials failed to show a survival advantage with the use of adjuvant tyrosine kinase inhibitors, albeit one of these trials did show a benefit in terms of disease-free survival. A number of trials evaluating other adjuvant treatments for high-risk RCC are currently underway including studies evaluating immune checkpoint inhibitors. In this chapter we summarize the literature on adjuvant therapy for high-risk localized renal cell carcinoma.