The role of cytoreductive nephrectomy (CN) has not yet been well characterized in the era of combination immunotherapy.
To evaluate characteristics and outcomes for patients with metastatic renal cell carcinoma (mRCC) who received immuno-oncology (IO)-based combination therapy according to CN status.
Using the International mRCC Database Consortium (IMDC), patients with mRCC who received frontline IO-based combinations were included. Upfront CN was defined as CN up to 3 mo before diagnosis of metastatic disease but before systemic therapy initiation. Deferred CN was defined as CN after systemic therapy initiation.
Overall survival (OS) from initiation of systemic therapy was estimated via Cox proportional-hazards regression. A 12-mo landmark time and a time-varying covariate for CN status were used to mitigate potential bias.
Of the 385 patients eligible for landmark analysis, 24, 182, and 179 underwent deferred CN, upfront CN, and no CN, respectively. Patients in the no CN subgroup were older (63 yr vs 57 yr in the deferred CN subgroup and 60 yr in the upfront CN subgroup; p = 0.001) and a higher proportion had bone metastases (44% vs 26% in the deferred CN subgroup and 23% in the upfront CN subgroup; p < 0.001). A lower proportion of patients in the upfront CN subgroup had IMDC poor risk (23% vs 43% in the no CN subgroup and 47% in the deferred CN subgroup; p < 0.001). On multivariable analysis, CN receipt was an independent favorable prognostic factor (hazard ratio 0.45, 95% confidence interval 0.26-0.78; p = 0.005). The study is limited by the lack of randomization and its retrospective nature.
Despite changes in practice patterns with the advent of novel therapeutic agents, CN may still serve as an effective surgical intervention in carefully selected patients.
For patients with metastatic kidney cancer, surgery to remove the primary tumor was traditionally the treatment of choice, but immunotherapy drugs are now another option for these patients. We analyzed data for contemporary patients with metastatic kidney cancer who received combination immunotherapy as their first treatment. We found that in selected patients receiving immunotherapy, surgery to remove the primary tumor as well can result in better prognosis.
European urology oncology. 2023 Oct 30 [Epub ahead of print]
Kosuke Takemura, Matthew S Ernst, Vishal Navani, J Connor Wells, Ziad Bakouny, Frede Donskov, Naveen S Basappa, Lori A Wood, Luis Meza, Sumanta K Pal, Bernadett Szabados, Thomas Powles, Benoit Beuselinck, Rana R McKay, Jae-Lyun Lee, D Scott Ernst, Anil Kapoor, Takeshi Yuasa, Toni K Choueiri, Daniel Y C Heng
Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. Electronic address: ., Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., BC Cancer Agency, Vancouver, BC, Canada., Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Aarhus University Hospital, Aarhus, Denmark; University Hospital of Southern Denmark, Esbjerg, Denmark., Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada., City of Hope Comprehensive Cancer Center, Duarte, CA, USA., Barts Cancer Institute, Queen Mary University of London, London, UK., Leuven Cancer Institute, KU Leuven, Leuven, Belgium., Moores Cancer Center, University of California San Diego, La Jolla, CA, USA., Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., London Regional Cancer Program, Western University, London, ON, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada., Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.