Oncological Outcomes of Delayed Nephrectomy After Optimal Response to Immune Checkpoint Inhibitors for Metastatic Renal Cell Carcinoma
Objective: To assess the oncological outcomes of patients who responded to ICI-based treatments and were subsequently treated with a delayed nephrectomy.
Design, setting, and participants: This national retrospective evaluation included 30 patients with mRCC who underwent a nephrectomy after a complete response (CR) or a major partial response (>80%) to ICI treatment at metastatic sites.
Intervention: Partial or radical nephrectomy after a favorable response to ICI treatment.
Outcome measurements and statistical analysis: Disease-free survival (DFS), progression-free survival (PFS), overall survival (OS), and potential discontinuation of systemic treatment were assessed.
Results and limitations: ICI-based treatments included ipilimumab-nivolumab (40%), ICI + tyrosine kinase inhibitor (10%), and nivolumab (50%). A delayed nephrectomy was performed after a median ICI treatment duration of 10 mo. In 19 cases (63.3%), surgeons faced difficulties due to adhesions or inflammatory changes. A complete pathological response was observed in 16.7% of patients. After a median follow-up of 19.5 mo after nephrectomy, 76.7% of patients achieved DFS. At 1 yr, 66.7% of patients were free from systemic treatment. The PFS and OS rates were, respectively, 96.7% and 100% at 1 yr, and 78.3% and 86.1% at 2 yr. Patients with a CR at metastatic sites had a better prognosis than those with a major partial response, in terms of DFS (p = 0.022) and PFS (p = 0.014).
Conclusions: Despite potentially challenging surgery, a delayed nephrectomy for patients who responded to ICI treatment provided promising oncological outcomes, and the majority of patients could discontinue systemic treatment.
Patient summary: In this study, we evaluated the clinical outcome in patients who responded well to immunotherapy, and subsequently underwent kidney ablation surgery. Three-quarters of patients experienced no recurrence, and in most cases, medical treatment could be discontinued.
Géraldine Pignot, Antoine Thiery-Vuillemin, Laurence Albigès, Jochen Walz, Hervé Lang, Loïc Balssa, Bastien Parier, Lionnel Geoffrois, Karim Bensalah, Friederike Schlürmann, Sylvain Ladoire, Pierre Bigot, Delphine Borchiellini, Ophélie Cassuto, Constance Thibault, Alexandre Ingels, Véronique Saldana, Guilhem Roubaud, Jean-Christophe Bernhard, Gwenaelle Gravis, Philippe Barthélémy
Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France; Medical Oncology Department, CHRU Besancon – Hopital Jean Minjoz, Besançon, France; Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France; Urology Department, University Hospital of Strasbourg, Strasbourg, France; Urology Department, CHRU Besancon – Hopital Jean Minjoz, Besançon, France; Urology Department, Bicêtre Hospital, Le Kremlin Bicêtre, France; Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre lès Nancy, France; Department of Urology, CHU Rennes – Hopital Pontchaillou, Rennes, France; Department of Medical Oncology, CHRU Brest, Brest, France; Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France; Urology Department, CHU d’Angers, Angers, France; Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France; Department of Medical Oncology, Polyclinique St Georges, Nice, France; Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France; Urology Department, CHU Henri-Mondor, Créteil, France; Department of Medical Oncology, CHU Henri-Mondor, Créteil, France; Department of Medical Oncology, Institut Bergonié, Bordeaux, France; Urology Department, CHU de Bordeaux – Hôpital Pellegrin, Bordeaux, France; Medical Oncology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, Marseille, France; Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
Source: Pignot G, Thiery-Vuillemin A, Albigès L. et al. "Oncological Outcomes of Delayed Nephrectomy After Optimal Response to Immune Checkpoint Inhibitors for Metastatic Renal Cell Carcinoma." European Urology Oncology. 2022. P577-584.