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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 5
| Issue : 1 | Page : 191 |
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Adjuvant pembrolizumab in renal cell carcinoma
Raghav Raodha, Ajay Gogia, Annie Baa
Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| Date of Submission | 10-Jan-2022 |
| Date of Decision | 22-Jan-2022 |
| Date of Acceptance | 23-Jan-2022 |
| Date of Web Publication | 24-Feb-2022 |
Correspondence Address:
Ajay Gogia
Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/crst.crst_10_22
How to cite this article:
Raodha R, Gogia A, Baa A. Adjuvant pembrolizumab in renal cell carcinoma. Cancer Res Stat Treat 2022;5:191 |
Choueiri et al.[1] have recently reported the benefit of adjuvant pembrolizumab for high-risk renal cell carcinoma (RCC) with a significant increase in the disease-free survival (DFS) compared to placebo. A subgroup analysis showed a significant DFS benefit of pembrolizumab in patients younger than 65 years of age and programmed death-ligand 1 (PD-L1) combined positive score (CPS)>1. This might be due to the occurrence of age-dependent changes in patients older than 65 years of age that include a reduced level of PD-L1 along with other immune modulation.[2],[3],[4] The median age of diagnosis of RCC in real-world settings is 65 years,[5],[6] hence it would be interesting to know how many patients aged over 65 years had PD-L1 CPS >1 and what their outcomes were. The adverse events (AEs) of adjuvant pembrolizumab and the drug discontinuation rate (DDR) were substantially higher as compared to placebo (AE grade 3–5, 32.4% vs. 17%, DDR, 20.7% vs. 2%, respectively). In view of the significant toxicity, modest improvement in overall survival, and no clinically significant difference in patient-reported outcomes (defined arbitrarily), adjuvant pembrolizumab should be used very cautiously.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Choueiri TK, Tomczak P, Park SH, Venugopal B, Ferguson T, Chang YH, et al. Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma. N Engl J Med 2021;385:683-94.  |
| 2. | Han Y, Liu D, Li L. PD-1/PD-L1 pathway: Current researches in cancer. Am J Cancer Res 2020;10:727-42. |
| 3. | Abraham G, Jobanputra KN, Noronha V, Patil VM, Menon NS, Gattani SC, et al. Immune checkpoint inhibitors in older patients with solid tumors: Real-world experience from India. Cancer Res Stat Treat 2021;4:270-6. [Full text] |
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| 5. | Chakiryan NH, Jiang DD, Gillis KA, Green E, Hajiran A, Hugar L, et al. Real-world survival outcomes associated with first-line immunotherapy, targeted therapy, and combination therapy for metastatic clear cell renal cell carcinoma. JAMA Netw Open 2021;4:e2111329. |
| 6. | Abbas W, Aggarwal A, Pankaj P, Jain R. Real-world data of second-line immunotherapy in metastatic clear cell renal cell carcinoma: A retrospective study. Cancer Res Stat Treat 2021;4:55-60. [Full text] |
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