How would you approach adjuvant systemic therapy for an isolated, oligometastatic CNS recurrence of RCC that was treated with SBRT?
Answer from: Medical Oncologist at Academic Institution
I tend not to treat patients with resected/irradiated CNS lesion(s) if there is no disease elsewhere. Such patients were not included in the adjuvant pembro study, the activity of any systemic therapy for CNS disease is not well-established, and in general, I worry single agent pembro is undertreatm...
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Answer from: Medical Oncologist at Academic Institution
KEYNOTE-564 study led to the approval of adjuvant pembrolizumab in patients with high-risk RCC, including those who had metastatectomy (M1-NED) (Choueiri et al., PMID 34407342). But, the trial excluded patients with brain and bone metastases. Therefore, there is no evidence-based guidance in this sc...
Answer from: Medical Oncologist at Community Practice
Brain metastases (BM) are a challenging manifestation of renal cell carcinoma and patients with brain metastases from renal cell carcinoma (RCC) have been underrepresented in clinical trials. In the absence of consensus guidelines and prospective data, one has to rely on retrospective experience.For...