Mohamad E. Allaf, MD, presented “Role of Neoadjuvant/ Adjuvant Immunotherapy in Patients with Localized Renal Cell Carcinoma: The PROSPER Trial and Beyond” during the 43rd Annual Ralph E. Hopkins Urology Seminar on January 31, 2024, in Jackson Hole, Wyoming.
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How to cite: Allaf, Mohamad E. “Role of Neoadjuvant/ Adjuvant Immunotherapy in Patients with Localized Renal Cell Carcinoma: The PROSPER Trial and Beyond.” January 31, 2024. Accessed Dec 2024. https://grandroundsinurology.com/role-of-neoadjuvant-adjuvant-immunotherapy-in-patients-with-localized-renal-cell-carcinoma-the-prosper-trial-and-beyond/
Role of Neoadjuvant/ Adjuvant Immunotherapy in Patients with Localized Renal Cell Carcinoma: The PROSPER Trial and Beyond – Summary
Mohamad E. Allaf, MD, reviews current literature on the role of neoadjuvant and adjuvant immunotherapy in treating localized renal cell carcinoma (RCC). He begins by establishing that surgical monotherapy fails to cure a significant proportion of patients with “localized” RCC thanks to micrometastatic disease.
Dr. Allaf then discusses how the inclusion of neoadjuvant therapies reduces the size of the tumor, controls potential metastases at the earliest point, and provides a litmus test for how appropriate it would be to treat the patient with surgical monotherapy. He also addresses adjuvant therapies, which can lower the likelihood of recurrence, and prolong patient survival. He acknowledges that older studies of adjuvant Tyrosine Kinase Inhibitor (TKI) therapy for RCC were negative, resulting in high toxicity and low effectiveness in treatment.
Dr. Allaf compares the performance of recent neoadjuvant checkpoint inhibitors in the metastatic setting to the current standard of care, demonstrating that the durability of disease response continued even after the therapy was discontinued. He then explores the rationale and early results supporting the administration of neoadjuvant therapy in localized RCC and how they laid the groundwork for the PROSPER trial.
The PROSPER trial was a Phase III international, randomized trial that examined the effect of a single dose of neoadjuvant checkpoint inhibitors 7-28 days before partial or radical nephrectomy. He presents the study design, the cohort composition, and the results, which did not support the use of neoadjuvant therapy for RCC patients.
Dr. Allaf concludes by presenting multiple recent studies supporting the use of adjuvant therapy for intermediate-high-risk and high-risk RCC patients. While adjuvant therapy has been approved for use by the FDA, additional trials and investigations are still needed to advance the field.
About The 43rd Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 43rd iteration of the meeting took place from January 31st to February 2nd, 2024, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Mohamad E. Allaf, MD, is Professor of Urology and Oncology, as well as Director of the Department of Urology and the Brady Urological Institute, Urologist-in-Chief of the Johns Hopkins Hospital, and Director of Minimally Invasive and Robotic Surgery. Dr. Allaf earned his medical degree from Johns Hopkins University, where he also completed his residency in urology.
