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At this point, the standard of care for patients with non-metastatic renal cell carcinoma (RCC) following surgical resection is observation until recurrence, states Daniel J. George, MD. As a result of this unmet need, several clinical trials are exploring a variety of treatments following nephrectomy.
The phase III ARISER trial explored adjuvant treatment with the G250-targeted chimeric monoclonal antibody girentuximab (Rencarex) compared to placebo for patients with clear cell RCC, explains Robert A. Figlin, MD. Unfortunately, results from this trial that were presented at the 2013 ASCO Annual Meeting did not demonstrate a significant advantage for treatment with girentuximab. However, a subset analysis indicated a benefit in some patients. In addition to this study, TKIs and immunomodulatory agents are under investigation in the adjuvant setting, Figlin states. However, the toxicity associated with adjuvant TKIs may be intolerable in this setting.
Since a treatment is not currently available, it is important to follow-up according to the NCCN guidelines, Figlin suggests. However, even follow-up in this space represents an area of unmet need, since gene expression profiles are not currently available to help select patients at high-risk of recurrence.