Introduction of adjuvant immunotherapy into the renal surgery pathway: Are eligible patients receiving treatment in time in the UK NHS setting?

Objective: The objective of the study is to identify uptake of adjuvant immunotherapy (AIO) and assess patient outcomes following partial or total nephrectomy for renal cell carcinoma (RCC). Patient and methods: Electronic health records of all patients who underwent partial or radical nephrectomy at a tertiary referral centre were reviewed to identify eligible RCC patients for AIO between 19/10/2022 and 19/10/2024. Hospital records of eligible patients were reviewed to obtain demographic information, details of oncological treatment, and treatment outcomes. Results: Of 143 patients who underwent operative management for suspected RCC, 40 were eligible to receive adjuvant immunotherapy. Thirty-six patients (90%) were offered referral to Oncology for adjuvant immunotherapy, of whom 34 were reviewed. Twenty-two patients (68.75%) consented to AIO. Twenty-one consented patients (95.5%) commenced AIO; one did not receive AIO due to being outside the required 12-week treatment window. Two patients (9.5%) had documented disease progression during AIO; one discontinued treatment and the other commenced Lenvatinib alongside AIO. A further nine (42.9%) patients stopped AIO due to drug toxicity. Conclusion: The majority of eligible patients were referred for AIO. Rates of progression on AIO in this ‘real-world’ setting were consistent with published clinical trial data; however, drug toxicity was higher. Pathway development is imperative to ensure that eligible patients are referred for AIO promptly due to time-critical eligibility criteria. Level of evidence: 2c