(UroToday.com) The International Kidney Cancer Symposium 2021 annual hybrid meeting included a role of perioperative therapy in renal cell carcinoma (RCC) session and a presentation by Dr. Mohamad Allaf discussing surgical considerations with perioperative therapy. Dr. Allaf notes that TKIs have been used as monotherapy or in combination with immunotherapy in the neoadjuvant setting, adjuvant setting, or both. However, there is an element of overtreatment and toxicity associated with the treatment given that many patients are cured by surgery alone. As such, the role of perioperative TKIs in non-metastatic RCC is not well defined. Downstaging of tumor thrombus has been reported, which may shrink the tumor, but the level and approach are the same with the added toxicity of treatment. Additionally, TKIs have been used to facilitate resectability (may shrink some tumors +/- easier resection) and potentially enable nephron-sparing surgery (may shrink tumors, potentially enabling more partial nephrectomies). However, whether this therapy decreases recurrence or increases overall survival is unknown.

X