Brief Correspondence Updated European Association of Urology Guidelines Regarding Adjuvant Therapy for Renal Cell Carcinoma Axel Bex a, *, Laurence Albiges b , Bo ¨rje Ljungberg c , Karim Bensalah d , Saeed Dabestani e , Rachel H. Giles f,g , Fabian Hofmann h , Milan Hora i , Markus A. Kuczyk j , Thomas B. Lam k,l , Lorenzo Marconi m , Axel S. Merseburger n , Michael Staehler o , Alessandro Volpe p , Thomas Powles q a Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; b Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France; c Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea ˚ University, Umea ˚, Sweden; d Department of Urology, University of Rennes, Rennes, France; e Department of Urology, Ska ˚ne University Hospital, Malmo ¨, Sweden; f Patient Advocacy, International Kidney Cancer Coalition, Duivendrecht, The Netherlands; g University Medical Centre Utrecht, Nephrology Department, Utrecht, The Netherlands; h Department of Urology, Sunderby Hospital, Sunderby, Sweden; i Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic; j Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany; k Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; l Academic Urology Unit, University of Aberdeen, Aberdeen, UK; m Department of Urology, Coimbra University Hospital, Coimbra, Portugal; n Department of Urology, University Hospital Schleswig-Holstein, Lu ¨beck, Germany; o Department of Urology, Ludwig-Maximilians University, Munich, Germany; p Division of Urology, Maggiore della Carita ` Hospital, University of Eastern Piedmont, Novara, Italy; q The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK E U R O P E A N U R O L O G Y X X X ( 2 0 1 6 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europea nurology.com Article info Article history: Accepted November 28, 2016 Associate Editor: James Catto Keywords: Renal cell cancer Management Adjuvant Sunitinib Sorafenib Guidelines Abstract The European Association of Urology Renal Cell Carcinoma (RCC) guidelines panel updated their recommendation on adjuvant therapy in unfavourable, clinically non- metastatic RCC following the recently reported results of a second randomised con- trolled phase 3 trial comparing 1-yr sunitinib to placebo for high-risk RCC after nephrectomy (S-TRAC). On the basis of conflicting results from the two available studies, the panel rated the quality of the evidence, the harm-to-benefit ratio, patient prefer- ences, and costs. Finally, the panel, including representatives from a patient advocate group (International Kidney Cancer Coalition) voted and reached a consensus to not recommend adjuvant therapy with sunitinib for patients with high-risk RCC after nephrectomy. Patient summary: In two studies, sunitinib was given for 1 yr and compared to no active treatment (placebo) in patients who had their kidney tumour removed and who had a high risk of cancer coming back after surgery. Although one study demonstrated that 1 yr of sunitinib therapy resulted in a 1.2-yr longer time before the disease recurred, the other study did not show a benefit and it has not been shown that patients live longer. Despite having been diagnosed with high-risk disease, many patients remain without recurrence, and the side effects of sunitinib are high. Therefore, the panel members, including patient representatives, do not recommend sunitinib after tumour removal in these patients. # 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Tel. +31 20 5122553; Fax: +31 20 5122554. E-mail address: a.bex@nki.nl (A. Bex). EURURO-7161; No. of Pages 4 Please cite this article in press as: Bex A, et al. Updated European Association of Urology Guidelines Regarding Adjuvant Therapy for Renal Cell Carcinoma. Eur Urol (2016), http://dx.doi.org/10.1016/j.eururo.2016.11.034 http://dx.doi.org/10.1016/j.eururo.2016.11.034 0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.