Projects

Choueiri et al.[1] have recently reported the benefit of adjuvant pembrolizumab for high‑risk renal cell carcinoma (RCC) with a significant increase in the disease‑free survival (DFS) compared to placebo. A subgroup analysis showed a significant DFS benefit of pembrolizumab in patients younger than 65 years of age and programmed death‑ligand 1 (PD‑L1) combined positive score (CPS)>1. This might be due to the occurrence of age‑dependent changes in patients older than 65 years of age that include a reduced level of PD‑L1 along with other immune modulation.[2‑4] The median age of diagnosis of RCC in real‑world settings is 65 years,[5,6] hence it would be interesting to know how many patients aged over 65 years had PD‑L1 CPS >1 and what their outcomes were. The adverse events (AEs) of adjuvant pembrolizumab and the drug discontinuation rate (DDR) were substantially higher as compared to placebo (AE grade 3–5, 32.4% vs. 17%, DDR, 20.7% vs. 2%, respectively). In view of the significant toxicity, modest improvement in overall survival, and no clinically significant difference in patient‑reported outcomes (defined arbitrarily), adjuvant pembrolizumab should be used very cautiously.