In renal cell carcinoma (RCC), continued advances in targeted therapy and immunotherapy have ushered patients with advanced disease into an era of long-term survival and chronic disease management. However, important clinical challenges remain, including optimizing adjuvant treatment for high-risk patients after surgery, selecting effective therapies following immunotherapy resistance, and developing multidisciplinary models for comprehensive care throughout the disease course.At the recent China Clinical Oncology Annual Advances Symposium (BOC) and Best of CSCO 2026 China, leading oncology experts gathered to discuss the latest international research advances and their translation into clinical practice. During the meeting, UroStream invited Prof. Pei Dong from Sun Yat-sen University Cancer Center to discuss recent progress in adjuvant therapy, later-line treatment, and individualized multidisciplinary management for kidney cancer.
UroStream:
In adjuvant therapy for kidney cancer, the LITESPARK-022 trial presented at this year’s ASCO GU introduced a targeted therapy–immunotherapy combination for high-risk patients. Based on these findings, how do you view the latest advances and future directions in adjuvant treatment?
Prof. Pei Dong:
The LITESPARK-022 study presented at this year’s ASCO GU provided important new evidence for postoperative adjuvant therapy in patients with high-risk renal cell carcinoma.
The trial compared pembrolizumab monotherapy with pembrolizumab plus belzutifan as adjuvant treatment following surgery in patients at high risk of recurrence.
The results demonstrated that, compared with pembrolizumab alone, the combination significantly improved disease-free survival (DFS), successfully meeting the trial’s primary endpoint.
However, overall survival (OS) data remain immature, and longer follow-up will be necessary to determine whether the combination ultimately translates into a long-term survival benefit.
Although the study produced positive results, toxicity management also deserves careful attention. Compared with pembrolizumab alone, the combination was associated with higher rates of adverse events such as hypoxia and anemia, requiring vigilant clinical monitoring and appropriate supportive care.
Patients receiving adjuvant therapy after surgery are generally disease-free at the time treatment begins. Therefore, the primary objective of adjuvant therapy is to reduce the long-term risk of recurrence. We should not focus solely on short-term efficacy but must also carefully balance long-term survival benefit against treatment tolerability.
Ultimately, whether this combination can improve overall survival will be the key determinant of its long-term clinical value.
UroStream:
In advanced kidney cancer, studies such as LITESPARK-011 and FRUSICA-2 have introduced new second-line options involving TKIs and targeted therapy–immunotherapy combinations. Your own team is also investigating novel combination strategies. Based on current evidence, how might these new regimens change the treatment landscape?
Prof. Pei Dong:
Selection of second-line therapy for advanced renal cell carcinoma depends heavily on the patient’s first-line treatment, and we can broadly divide patients into two major groups.
The first group includes patients whose disease progresses after TKI monotherapy.
For these patients, targeted therapy–immunotherapy combinations have substantially improved treatment outcomes. The FRUSICA-2 study demonstrated that fruquintinib plus sintilimab, compared with investigator’s choice of axitinib or everolimus monotherapy, significantly prolonged progression-free survival (PFS) and improved the objective response rate (ORR).
The second group represents one of the greatest challenges in current clinical practice: patients whose disease has become resistant to first-line immunotherapy.
To date, immunotherapy rechallenge has not consistently demonstrated clear or durable clinical benefit. Consequently, developing combinations with novel mechanisms of action to overcome immune resistance remains a major research priority.
The recently reported LITESPARK-011 study compared lenvatinib plus belzutifan with cabozantinib and demonstrated that this dual targeted approach significantly prolonged PFS in patients with treatment-resistant disease.
Looking ahead, combinations such as lenvatinib plus belzutifan, as well as regimens incorporating mTOR inhibitors, represent promising multi-pathway therapeutic strategies that may substantially expand later-line treatment options for patients who develop resistance to immunotherapy.
UroStream:
With the introduction of novel treatment strategies and increasing standardization of care, the 5-year survival rate for advanced kidney cancer in China has increased from less than 20% to more than 50%, making chronic disease management a clinical reality. Looking forward, what additional developments do you believe will further improve outcomes for Chinese patients?
Prof. Pei Dong:
As targeted therapy combined with immunotherapy becomes the standard approach for advanced kidney cancer in China, long-term survival is no longer an unrealistic goal—it is increasingly becoming a clinical reality.
As systemic therapies continue to improve, our attention is shifting toward multidisciplinary, longitudinal management throughout the entire disease course.
This approach extends far beyond simply selecting drugs according to disease stage. Instead, it emphasizes patient-centered, individualized care from diagnosis through long-term follow-up.
In daily practice, we formulate treatment strategies based on each patient’s overall disease characteristics, including tumor burden, metastatic pattern, and disease dynamics.
For example, patients with oligometastatic disease may benefit from local treatment directed specifically at metastatic lesions, allowing effective control of limited metastatic sites.
Similarly, patients with oligoprogressive disease do not necessarily require an immediate change in systemic therapy. Instead, local interventions—including radiotherapy, ablation, or surgery—can be used to treat the progressing lesions while maintaining the existing systemic regimen, thereby extending the duration of disease control.
Consequently, particularly in the later-line setting, we increasingly emphasize individualized, multidisciplinary management throughout the entire disease course.
The future of kidney cancer treatment will involve much more than continued advances in systemic therapy alone. Rather, it will require the thoughtful integration of surgery, radiotherapy, interventional procedures, and systemic therapies, tailored to each patient’s specific clinical circumstances, with the ultimate goal of enabling patients to live longer while maintaining a better quality of life.
Prof. Pei Dong
