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Dr. Brian Rini: Neoadjuvant therapy for RCC evolving, immuno-oncology era coming

BY NEIL OSTERWEIL

MDedgeNews

Neoadjuvant therapy for primary renal cell carcinoma tumors is an evolving field, according to Brian Rini, MD, professor of hematology and medical oncology at the Cleveland Clinic.

“It’s been tricky and there is no standard of care in neoadjuvant therapy,” he said in an interview at the annual meeting of the American Society of Clinical Oncology in Chicago.

Though most primary tumors will shrink with neoadjuvant use of a vascular endothelial growth factor (VEGF) inhibitor by about 30%, the absolute decrease is about 1 cm in size. It’s not the case, as in some other solid malignancies, that the tumors will melt away and surgery can be avoided altogether.

“Where we found it useful…is in specific circumstances where a little bit of shrinkage of the primary tumor can matter…where you are trying to save as much functioning nephrons as possible and do a partial nephrectomy,” he said.

Brian Rini, MD

Targeted therapy in the adjuvant setting is somewhat controversial, Dr. Rini continued, weighing in on the six large, randomized trials evaluating VEGF inhibitors. “You’ll get a lot of strong opinions from people who think about this a lot.”

When treating patients himself, Dr. Rini tends to consider the benefit from adjuvant treatment, particularly in patients with good performance status or other clinical features suggesting that they could benefit from a tyrosine kinase inhibitor.

Looking to the future, Dr. Rini says that we are about to enter the immuno-oncology era in the adjuvant setting, noting that many ongoing trials will be reporting results in the next few years.