Nachsorge und adjuvante Therapie des fortgeschrittenen Nierenzellkarzinoms

Abstract

Specialist care following (nephron-sparing) kidney surgery serves to detect postoperative complications and to monitor kidney function and cardiovascular health. From an oncological point of view, the early detection of local and contralateral recurrences as well as (single) distant metastases in the early disease stages is paramount. This enables the option of metastasis-directed surgery to delay systemic therapies. On the other hand, the early detection of distant metastases can facilitate the initiation of necessary systemic therapies. In general, nephron-sparing surgery is recommended as the first-line treatment of choice for localized renal tumors. Current guidelines recommend arisk-adapted follow-up based on histopathological criteria (pT, pN or Rstatus). For patients with intermediate and high-risk findings, aftercare should be intensified. In addition to routine blood tests, cross-sectional imaging using contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) remain the method of choice. Recently presented results of the phaseIII KEYNOTE-564 study on the adjuvant therapy with the programmed cell death1 (PD1) inhibitor pembrolizumab in clear cell, locally advanced renal cell carcinoma (≥ pT1 GII and or ≥ N+) or oligometastatic renal cell carcinoma without evidence of distant metastases (e.g., after metastasis surgery < 1year after nephrectomy) demonstrated an advantage in terms of disease-free survival compared to follow-up alone. However, overall survival results are pending. Other potentially effective adjuvant concepts including atezolizumab, nivolumab/ipilimumab, everolimus or pembrolizumab/belzutifan are currently being investigated in clinical trials.