Giuseppe Banna, Head of Translational Research and Clinical Trials Unit of Thoracic Tumours at Candiolo Cancer Institute IRCCS and Consultant Medical Oncologist for Lung and Urology at Portsmouth Hospitals University NHS Trust, shared a post on LinkedIn about a paper he co-authored with colleagues published in Chinese Clinical Oncology:
“Adjuvant immunotherapy in urology: The critical challenge of irAEs.
Adjuvant immunotherapy holds promise in urological cancers but introduces a unique clinical dilemma: the risk of significant, often irreversible immune-related adverse events (irAEs) in patients who are potentially already cured by surgery.
Our narrative review in Chinese Clinical Oncology synthesizes the key evidence:
Efficacy: ICIs like nivolumab and pembrolizumab show improved DFS in high-risk UC and RCC (CheckMate-274/KEYNOTE-564).
The Toxicity Problem: Grade ≥3 irAEs, particularly endocrine (thyroiditis, adrenal insufficiency), are frequent and can be permanent, requiring lifelong management.
The Adjuvant Paradox: Balancing DFS benefit against chronic toxicity is complex, especially when overall survival benefit is not always clear.
The Path Forward: Refined patient selection is critical. Biomarkers like hashtag#ctDNA are key to identifying patients with minimal residual disease who truly need treatment, sparing others unnecessary risk.
Conclusion: While a significant advance, adjuvant ICI use requires caution, sophisticated risk stratification, and thorough patient discussion.”
Title: Narrative review on immune-related adverse events (irAEs) of immune checkpoint inhibitors in the adjuvant therapy of urological cancers
Authors: Riya Sabharwal, Artur Vysotskyi, Giuseppe Luigi Banna, Akash Maniam
You can read the Full Article in Chinese Clinical Oncology.
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