RCC — SCE Medical Oncology MCQ

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ModerateUrological CancersRCCSCE Medical Oncology

A 55-year-old man with clear cell RCC has a complete nephrectomy and pathology shows pT3a N0 M0 (renal vein involvement), Fuhrman grade 4. What adjuvant therapy should be discussed?

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Correct answer: E — Pembrolizumab for 1 year

Adjuvant pembrolizumab for 1 year is NICE-approved for resected clear cell RCC at high risk of recurrence (NICE TA830, KEYNOTE-564 trial). KEYNOTE-564 demonstrated significant DFS and OS benefit for pembrolizumab over placebo in high-risk resected RCC (including pT3-T4, any N+, or M1 resected). Adjuvant sunitinib (S-TRAC trial) showed DFS benefit but no OS benefit and has significant toxicity — not recommended by NICE.

Reference: NICE TA830 Pembrolizumab for adjuvant treatment of RCC; KEYNOTE-564 Choueiri et al NEJM 2024