Adding belzutifan to adjuvant pembro improved disease-free survival (DFS), but overall survival (OS) remains immature and was not statistically different. This is a compelling signal that makes sense, but I would still be a bit cautious adding this until OS maturity. There is clearly an increase in rates of anemia and lung toxicity, which in the adjuvant setting need careful consideration.
Belzutifan beat everolimus in progression-free survival (PFS) and response rate, but hardly anyone uses it alone, mostly used in combination with Lenvatinib.
It is yet another option for renal cell cancer patients.
This is helpful when we get patients who have a renal mass as this may help distinguish between benign vs malignant.
Adjuvant pembrolizumab improves overall survival (reduced mortality by 38%). We need to make sure that urologists are also aware so those patients with a high risk of recurrence can get this medication.
An intriguing study from the UK, patients had 24 weeks of sunitinib or pazopanib followed by a continuation or treatment holiday. Non-inferiority could not be established, but there was seemingly no meaningful reduction in OS (28 vs. 27 months overall), with a noticeable improvement in toxicity in the treatment break group. This may be a realistic strategy for patients with a focus on QOL or cost-effectiveness.
Pembrolizumab remains the only adjuvant option for high risk RCC after curative surgery. The OS curves seem to be beginning to separate and hope to be positive with longer f/u. The ongoing Durvalumab + Tremilumumab will be an interesting adjuvant study for RCC when the results are available.