EURURO Vol. 71 No. 5

Brief Correspondence

Updated European Association of Urology Guidelines Regarding

Adjuvant Therapy for Renal Cell Carcinoma

Axel Bex

a , * ,

Laurence Albiges

b ,

Bo¨rje Ljungberg

c ,

Karim Bensalah

d ,

Saeed Dabestani

e ,

Rachel H. Giles

f , g ,

Fabian Hofmann

h ,

Milan Hora

i ,

Markus A. Kuczyk

j ,

Thomas B. Lam

k , l ,

Lorenzo Marconi

, Axel S. Merseburger

n ,

Michael Staehler

o ,

Alessandro Volpe

p ,

Thomas Powles

Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;

Department of Cancer

Medicine, Institut Gustave Roussy, Villejuif, France;

Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea˚ University, Umea˚,

Sweden;

Department of Urology, University of Rennes, Rennes, France;

Department of Urology, Ska˚ne University Hospital, Malmo¨, Sweden;

Patient

Advocacy, International Kidney Cancer Coalition, Duivendrecht, The Netherlands;

University Medical Centre Utrecht, Nephrology Department, Utrecht, The

Netherlands;

Department of Urology, Sunderby Hospital, Sunderby, Sweden;

Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen,

Charles University in Prague, Prague, Czech Republic;

Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany;

Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK;

Academic Urology Unit, University of Aberdeen, Aberdeen, UK;

Department of Urology,

Coimbra University Hospital, Coimbra, Portugal;

Department of Urology, University Hospital Schleswig-Holstein, Lu¨beck, Germany;

Department of

Urology, Ludwig-Maximilians University, Munich, Germany;

Division of Urology, Maggiore della Carita` Hospital, University of Eastern Piedmont, Novara,

Italy;

The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 1 9 – 7 2 2

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journal homepage:

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Article info

Article history:

Accepted November 28, 2016

Associate Editor:

James Catto

Keywords:

Renal cell cancer

Management

Adjuvant

Sunitinib

Sorafenib

Guidelines

Abstract

The European Association of Urology Renal Cell Carcinoma (RCC) guidelines panel

updated their recommendation on adjuvant therapy in unfavourable, clinically non-

metastatic RCC following the recently reported results of a second randomised con-

trolled phase 3 trial comparing 1-yr sunitinib to placebo for high-risk RCC after

nephrectomy (S-TRAC). On the basis of conflicting results from the two available studies,

the panel rated the quality of the evidence, the harm-to-benefit ratio, patient prefer-

ences, and costs. Finally, the panel, including representatives from a patient advocate

group (International Kidney Cancer Coalition) voted and reached a consensus to not

recommend adjuvant therapy with sunitinib for patients with high-risk RCC after

nephrectomy.

Patient summary:

In two studies, sunitinib was given for 1 yr and compared to no active

treatment (placebo) in patients who had their kidney tumour removed and who had a

high risk of cancer coming back after surgery. Although one study demonstrated that

1 yr of sunitinib therapy resulted in a 1.2-yr longer time before the disease recurred, the

other study did not show a benefit and it has not been shown that patients live longer.

Despite having been diagnosed with high-risk disease, many patients remain without

recurrence, and the side effects of sunitinib are high. Therefore, the panel members,

including patient representatives, do not recommend sunitinib after tumour removal in

these patients.

* Corresponding author. Department of Urology, The Netherlands Cancer Institute, Antoni van

Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.

Tel. +31 20 5122553; Fax: +31 20 5122554.

E-mail address:

a.bex@nki.nl

(A. Bex).

http://dx.doi.org/10.1016/j.eururo.2016.11.034

0302-2838/