(UroToday.com) The 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between January 25th and 27th was host to a renal cell, adrenal, penile, urethral, and testicular cancers poster session. Dr. Dimitrios Makrakis presented the results of a systematic review and individual patient data meta-analysis evaluating the role of cytoreductive nephrectomy for metastatic renal cell carcinoma (RCC) in the immune checkpoint inhibitor era.
There is ongoing debate regarding the value of cytoreductive nephrectomy in patients with metastatic RCC, with original data from the interferon era supporting this approach later on challenged by more recent evidence from the non-inferiority CARMENA trial conducted in the TKI (sunitinib) era.1 The role of cytoreductive nephrectomy in the immune checkpoint inhibitor era remains to be determined. As such, Dr. Makrakis and colleagues performed a systematic review and meta-analysis investigating potential survival benefits with cytoreductive nephrectomy in metastatic RCC patients treated with ICIs.
The investigators performed a systematic search of MEDLINE, Web of Science, and EMBASE databases to identify studies comparing systemic therapy with ICI + cytoreductive nephrectomy to ICI therapy alone in metastatic RCC patients. Using published Kaplan-Meier overall survival curves, the investigators ‘reconstructed’ individual patient data and then performed one-stage and two-stage meta-analyses with both parametric and non-parametric effect estimates. Six- and 12-months landmark analyses were performed to account for potential immortal time biases. Subgroup analyses by ICI line of treatment were also performed. The risk of bias was assessed using the ROBINS-I tool.
The investigators identified eight retrospective studies that met the inclusion criteria, for a total of 2,319 patients. Patients receiving cytoreductive nephrectomy were generally younger (median age: 58 versus 62 years), had a lower incidence of liver metastases, and more favorable IMDC risk scores. The combination of cytoreductive nephrectomy and ICIs was associated with longer overall survival outcomes across all analyses, as summarized below. This held true for the analysis of 1st line versus subsequent ICI subgroups.
The investigators concluded that the currently available evidence for cytoreductive nephrectomy in the ICI era is limited to retrospective studies. While this meta-analysis provides additional support for such an approach, the role of upfront versus delayed (consolidative) cytoreductive nephrectomy remains unclear, and prospective trials evaluating this are eagerly anticipated (e.g., PROBE [SWOG S1931]).
Presented by: Dimitrios Makrakis, MD, Resident Physician, Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine, New York. NY
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, January 25th – January 27th, 2024
Related content: The Role of Nephrectomy with Immunotherapy in Metastatic Renal Cell Carcinoma - Dimitrios Makrakis
- Mejean A, Ravaud A, Thezenas S, et al. Sunitinib alone or after nephrectomy in metastatic renal cell carcinoma. N Engl J Med 2018 Aug 2;379(5):417-427.