The UroOnc Minute: Adjuvant Therapy in Renal Cell Carcinoma, with Brian Shuch, MD

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, is joined by Brian M. Shuch, MD, associate professor of urology at the University of California, Los Angeles and a nationally recognized expert in kidney cancer, for a concise yet wide-ranging update on the evolving role of adjuvant therapy in renal cell carcinoma (RCC). Shuch outlines the central challenge facing clinicians after “curative” nephrectomy: despite complete surgical resection, a substantial proportion of patients with high-risk disease will recur and ultimately die from metastatic RCC.

Against this backdrop, he reviews the long and often disappointing history of adjuvant approaches in kidney cancer, from largely ineffective tyrosine kinase inhibitors to a series of negative immunotherapy trials. He then highlights the pivotal shift marked by adjuvant pembrolizumab in KEYNOTE-564 (NCT03142334), which demonstrated an improvement in disease-free survival and overall survival,¹ though Shuch recognized concerns about the study design that may impact clinical interpretation.

Shuch then walked listeners through what is currently known about patient selection, treatment options, and emerging data, emphasizing which patients appear to benefit most—those with high-stage, high-grade tumors, node-positive disease, or resected metastatic disease (M1 NED). He also discusses recent and upcoming trial results, including data presented at ESMO and anticipated readouts at ASCO GU, underscoring how rapidly this space is moving and what may soon enter clinical practice.

The conversation closes with a forward-looking discussion on biomarkers, including circulating tumor DNA and kidney injury molecule-1 (KIM-1), and the unmet need for reliable tools to better predict recurrence risk. Together, Weiner and Shuch provide practicing urologists with a high-yield snapshot of where adjuvant RCC therapy stands today, and where it may be headed next.

REFERENCE

1. Choueiri TK, Tomczak P, Park SH, et al. Overall Survival with Adjuvant Pembrolizumab in Renal-Cell Carcinoma. N Engl J Med. 2024;390(15):1359-1371. doi:10.1056/NEJMoa2312695