Abstract
The problem of choosing an optimal therapy reducing the risk of relapse after surgery in patients with renal cell carcinoma is highly relevant in oncology. Targeted drugs that have been shown to be effective for metastatic renal cell carcinoma are being actively investigated as an adjuvant therapy option. However, the results of these studies are controversial. There is still no evidence that such therapy can increase overall or relapse-free survival. Novel immune drugs, such as immune checkpoint inhibitors, can change an approach to adjuvant therapy of renal cell carcinoma. In 2021, the interim results of a large-scale, randomized, double-blind trial launched in 2017 (KEYNOTE-564) were published. It analyzed the efficacy of pembrolizumab as an adjuvant therapy for renal cell carcinoma in patients after nephrectomy. Pembrolizumab significantly increased the 2-year relapse-free survival rate (77.3% vs 68.1% in the placebo group); the odds ratio for the risk of recurrence or death was 0.68 (95% confidence interval 0.53–0.87; р = 0.002). Usually, RCC patients after nephrectomy tolerate pembrolizumab well; however, not all of them respond to treatment. Obviously, all candidates to receive immune checkpoint inhibitors (pembrolizumab, etc.) should undergo serious preliminary selection, especially those with an intermediate risk of relapses after nephrectomy, in order to optimize distribution of such drugs among patients.
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