Pro: Adjuvant Therapy: Debating the Role of Adjuvant Therapy for All

How to cite: McKay RR. “Pro: Adjuvant Therapy in RCCPro: Adjuvant Therapy in RCC – Debating the Role of Adjuvant Therapy for All.” November 13, 2025. Accessed Apr 2026. https://grandroundsinurology.com/pro-adjuvant-therapy-debating-the-role-of-adjuvant-therapy-for-all

Summary

Rana R. McKay, MD, FASCO, Professor of Medicine, Urology, Radiation Medicine, and Applied Sciences, University of California, San Diego, San Diego, California, argues in favor of adjuvant therapy for high-risk localized renal cell carcinoma following nephrectomy. Dr. McKay focuses on recurrence risk assessment, clinical trial evidence, and practical considerations that support the routine use of adjuvant immunotherapy in appropriately selected patients.

She begins with a case of a patient with clear cell renal cell carcinoma featuring high-risk pathologic characteristics. Multiple validated recurrence risk models are reviewed, demonstrating substantial recurrence risk despite favorable overall survival estimates. The distinction between recurrence-free survival and overall survival is emphasized as central to adjuvant decision-making.

Dr. McKay reports that effective adjuvant therapy should delay progression, limit toxicity, be easy to administer, and improve overall survival. Data from KEYNOTE-564 are reviewed, demonstrating that adjuvant pembrolizumab significantly delays disease progression, with early and sustained separation of disease-free survival curves. Additional supportive evidence from the RAMPART trial and the LiteSpark-022 study is discussed, reinforcing the role of adjuvant immunotherapy in high-risk populations.

Negative adjuvant immunotherapy trials are addressed in detail, with emphasis on differences in study design, patient selection, treatment duration, and therapeutic intensity. These trials are presented as limited by methodological issues rather than as evidence against the efficacy of adjuvant therapy.

Toxicity and quality-of-life data are reviewed, demonstrating low rates of high-grade adverse events, no treatment-related deaths, manageable discontinuation rates, and no clinically meaningful deterioration in patient-reported outcomes. Ease of administration is highlighted, including six-week dosing schedules and emerging subcutaneous formulations.

Dr. McKay emphasizes that adjuvant pembrolizumab is the first therapy in kidney cancer to demonstrate an overall survival benefit in the adjuvant setting and supports its use for patients at high risk of recurrence.

About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.