Renal cell carcinoma—presentation highlights from the ESMO Congress 2021

In this short review article we discuss three key oral presentations from the European Society for Medical Oncology (ESMO) Congress 2021 concerning localised, as well as advanced/metastatic renal cell carcinoma, highlighting their potential implications for the improvement of therapeutic modalities in affected patients. (1) Conditional survival and 5‑year follow-up of CheckMate 214 currently represent the longest available phase III follow-up data in the first-line (combination) treatment of clear cell renal cell carcinoma patients with nivolumab + ipilimumab vs. sunitinib. This analysis demonstrated durable efficacy benefits with the respective combination vs. sunitinib. Moreover, conditional survival results predict an increased probability of durable overall survival, progression-free survival, and response rates with nivolumab + ipilimumab at 2‑ and 3‑year landmarks. (2) The randomised, double-blind, phase III KEYNOTE-564 study, presented as a highlight late-breaking abstract at the ASCO Congress 2021, met its primary endpoint of disease-free survival with post nephrectomy adjuvant pembrolizumab vs. placebo in clear cell renal cell carcinoma patients. At ESMO 2021, the authors presented patient-reported outcomes, whereby no clinically meaningful changes from baseline in health-related quality of life or symptom scores were observed with adjuvant pembrolizumab or placebo. These findings suggest that adjuvant pembrolizumab was tolerable from a patient perspective. (3) A phase II prospective trial of frontline cabozantinib in metastatic collecting ducts carcinoma, namely the BONSAI trial (Meeturo 2), met its primary endpoint objective response rate, showing promising efficacy and acceptable tolerability of cabozantinib in respective patients. Since metastatic collecting ducts carcinoma is biologically poorly characterised and heavily underrepresented in prospective randomised trials, BONSAI gains particular importance.