Invited discussant Daniel M. Geynisman, MD, of Fox Chase Cancer Center, Philadelphia, found the longer-term follow-up of KEYNOTE-564 “reassuring.”

Dr. Geynisman continued: “Following nephrectomy, the goal of adjuvant treatment is to ideally cure or at least significantly delay disease progression. The disease-free survival curves in the updated analysis separate even further with an additional 6 months of follow-up, which is promising for adjuvant pembrolizumab. There was particular benefit in patients with very high-risk disease, those with sarcomatoid features, and those who already had metastatic disease. We still need be very mindful of potential toxicity, and thus a personalized discussion based on individual risk is necessary for each patient.”

“Although we don’t know yet whether adjuvant pembrolizumab will result in more cures, it clearly helps prevent recurrence. Thus, in my clinical practice, I will feel more comfortable recommending adjuvant pembrolizumab to patients at high risk for recurrence, but will be sure to discuss the as-of-yet immature overall survival results and key possible toxicities.” he stated. 

DISCLOSURE: Dr. Geynisman has served as a consultant or advisor to AstraZeneca, Eisai, Exelixis, Merck, Myovant Sciences, Pfizer, and Seattle Genetics/Astellas and has received institutional research funding from Astellas Pharma, Calithera Biosciences, Genentech, and Merck.