Weighing the Risks and Benefits of Adjuvant Therapy for Kidney Cancer

Adjuvant therapy can be beneficial for some patients with kidney cancer, but it’s important for each patient to weigh the treatment benefit and potential risk for toxicity, according to a presentation at CURE®’s Educated Patient® Kidney Cancer Summit.

“Like all medical decisions, it’s a balance between risks and benefits,” Dr. Tian Zhang, an associate professor in the Division of Hematology and Oncology at UT Southwestern Medical Center in Dallas, Texas said in an interview with CURE®. She explained that adjuvant therapy is treatment given without measurable disease, meaning it is administered after a cancer has been resected or surgically removed.

Adjuvant therapy does have the benefit of delaying disease recurrence, she said, although it comes with toxicities and side effects which may affect a patient’s quality of life. Weighing these risks and benefits should be based on patient preference.

Zhang highlighted two drugs in the adjuvant setting for this patient population: Sutent (sunitinib) and Keytruda (pembrolizumab). Of note, awareness is high on toxicities and how it will affect patients, she said.

In a previous trial, Sutent did improve disease-free survival compared with placebo. Despite this finding, 48% of patients experienced severe side effects. Some of these side effects, Zhang said, included high blood pressure, a rash on the hands and feet, mouth ulcers, nausea and diarrhea. This drug was approved by the Food and Drug Administration (FDA) in 2017 for use in the adjuvant setting, although real-world use is not as widespread due to the limited benefit but high side effect occurrence. Zhang explained this is usually recommended to younger patients who have high anxiety about recurrence and can tolerate toxicity.

One year of treatment with Keytruda did improve disease-free survival compared with placebo and gave “promising” results at the median follow up of two years. Zhang said this is well tolerated for a majority of patients, but there can be a significant immune-mediated toxicity for some. Some of these side effects include rash, diarrhea, thyroid inflammation, alterations in the pancreas and inflammation in the liver, lungs and kidneys. Keytruda in this setting is currently under priority review by the FDA.

She added that most of these side effects are manageable with steroids. For a small portion of patients, the side effects can be severe and potentially fatal, making it important for patients to be aware of them to recognize them early.

“Thinking through the toxicity profile is really important when you think about the potential risks of being on treatment,” Zhang noted. “Making sure that a patient knows (about the) side effects (and) what to look out for will help them identify those early on be able to navigate and advocate for themselves to be able to get their side effects treated earlier.”

Zhang added that although these side effects can affect quality of life, when comparing those who took Keytruda with placebo, there was not significant difference in quality of life.

“It is going to affect their quality of life if they have that rare, severe (side effect). But for the majority of patients, it’s generally well tolerated,” she added.

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