To evaluate effect and outcomes of combination primary immunotherapy (IO) and nephrectomy for advanced renal cell carcinoma (RCC).
We conducted a multicenter, retrospective analysis of patients with advanced/metastatic RCC who received IO followed by nephrectomy. Primary outcome was Bifecta (negative surgical margins and no 30-day surgical complications). Secondary outcomes included progression-free survival (PFS) following surgery, reduction in tumor/thrombus size, RENAL score, and clinical/pathologic downstaging. Cox regression multivariable analysis was conducted for predictors of Bifecta and PFS. Kaplan-Meier analysis assessed PFS, comparing Bifecta and non-Bifecta groups.
A total of 56 patients were analyzed (median age 63 years; median follow-up 22.5 months). A total of 40 (71.4%) patients were intermediate IMDC risk. Patients were treated with immunotherapy for median duration of 8.1 months. Immunotherapy resulted in reductions in tumor size (P < .001), thrombus size (P = .02), and RENAL score (P < .001); 38 (67.9%) patients were clinically downstaged on imaging (P < .001) and 25 (44.6%) patients were pathologically downstaged following surgery (P < .001). Bifecta was achieved in 38 (67.9%) patients. Predictors for bifecta achievement included decreasing tumor size (HR 1.08, P = .043) and pathological downstaging (HR 2.13, P = .047). Bifecta (HR 5.65, P = .009), pathologic downstaging (HR 5.15, P = .02), and increasing reduction in tumor size (HR 1.2, P = .007) were associated with improved PFS. Bifecta patients demonstrated improved 2-year PFS (84% vs. 71%, P = .019).
Primary immunotherapy reduced tumor/thrombus size and complexity. Pathologically downstaged patients were more likely to achieve bifecta, and these patients displayed improved 2-year PFS. Our study supports further inquiry in the use of CRN following primary immunotherapy for advanced renal cancer.
Clinical genitourinary cancer. 2023 Jul 19 [Epub ahead of print]
Kevin Hakimi, Ava Saidian, Justine Panian, Pedro Barata, Stephanie Berg, Steven L Chang, Renee M Saliby, Hannah Dzimitrowicz, Hamid Emamekhoo, Evan Gross, Deepak Kilari, Elaine Lam, Mimi Nguyen, Margaret Meagher, Luke Wang, Grant P Rauterkus, Vincent D'Andrea, Kendrick Yim, Sarah Psutka, Bicky Thapa, Nicole Weise, Tian Zhang, Rana R McKay, Ithaar H Derweesh
Department of Urology, UC San Diego School of Medicine, San Diego, CA., Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA., Department of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, LA., Department of Hematology and Medical Oncology, Loyola University Medical Center, Maywood, IL., Division of Urology, Brigham and Women's Hospital, Boston, MA., Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA., Department of Medicine, Duke University School of Medicine, Durham, NC., Department of Hematology and Medical Oncology, University of Wisconsin School of Medicine, Madison, WI., Department of Hematology and Medical Oncology, University of Washington School of Medicine, Seattle, WA., Division of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI., Department of Hematology and Medical Oncology, University of Colorado School of Medicine, Aurora, CO., Department of Hematology and Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology, UC San Diego School of Medicine, San Diego, CA. Electronic address: .