Abstract

Background: Renal cell carcinoma (RCC) is responsible for 4% of all neoplasms in adults and 80% of all primary renal tumours. In the European Union, there are almost 84000 new cases and 35000 deaths each year due to RCC. In the last five decades, patients with localised RCC will develop recurrence of disease after nephrectomy in about 50% of cases. Considering the number of novel targeted therapies approved in the last years for the treatment of mRCC, there has been great interest to assess the efficacy of the same agents in the adjuvant setting.

Objective: to provide a systematic review of literature on the available data to define whether adjuvant treatment plays a role in the management of RCC.

Methods: A literature search using PubMed was carried out with no date restriction up to November 2016. A computerized search of the abstracts reported at ASCO and ESMO library, and www.clinicaltrial.gov was performed in order to identify relevant unpublished studies and ongoing trials.

Results: the search strategy returned 908 entries: after the exclusion of 886 irrelevant publications, 22 studies were eligible for the systematic review.

Conclusion: Currently, there is no robust evidence for the adjuvant treatment for patients with localized RCC at high risk of recurrence post-nephrectomy and often data are conflicting.

It is necessary to identify new prognostic factors that might better predict the risk of relapse after surgery. The enrolment in adjuvant trials should be encouraged for the identification of selected patients who might benefit from adjuvant treatment.

Keywords: Adjuvant therapy, immunotherapy, kinase inhibitors, m-Tor inhibitors, vaccines, renal cell carcinoma.

Graphical Abstract