Martin H. Voss, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses treatment in the neoadjuvant setting for patients with kidney cancer.

There is a large body of data in the adjuvant setting using the medications that were developed in the metastatic setting. Almost all approved adjuvant agents have been in post-operative development, explains Voss.

In the neoadjuvant setting, there are many trials that have been testing tyrosine kinase inhibitors (TKIs). None of those trials have been randomized, so the outcome cannot be compared to surgery alone. The primary endpoint of these studies were surgical endpoints, such as operative feasibility, resectable disease, or shrinking primary tumors.

The FDA recently has approved cabozantinib (Cabometyx) for previously untreated patients with advanced kidney cancer, based on a meaningful improvement in progression-free survival versus sunitinib (Sutent) in the CABOSUN trial.