In this study we evaluated outcomes of patients with metastatic renal cell carcinoma who received immunotherapy before surgery. We found that receiving immunotherapy combinations before surgery can offer patients benefits in reducing tumor size and improving disease control.
Immunotherapy (IO) has improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, the timing of surgical intervention for cytoreductive nephrectomy (CN) is still controversial for this group of patients.
We identified patients with mRCC receiving IO-based therapies and undergoing CN. Patients were divided into 2 cohorts: those who underwent upfront CN and those who underwent deferred CN. Pathologic and radiographic features along with clinical outcomes were systematically collected. Comparisons were performed using Chi-square test, paired t-Test or Mann-Whitney-U test. Progression Free survival (PFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method.
Fifty-one patients with mRCC were included, with a median follow-up of 21 months. 38 (74.5%) patients received IO-based therapies prior to CN, while 13 (25.5%) patients underwent up-front CN. IO-based therapies reduced median tumor size from pretreatment 10 cm to 8.6 cm post-treatment when given prior to CN. IO-TKI had a trend toward higher tumor shrinkage (-2.3 vs -1.2 cm). Pathologic T downstaging occurred in 42% (n=16) of patients, 11% (n=4) of whom had pT0 disease. Thrombus downstaging occurred in 13% (n=6) of patients, all with either partial response (PR) or complete response (CR) in metastases. PFS (HR=0.7, 95% CI 0.29-1.98, p=0.58) and OS (HR 0.4, 95% CI 0.13-1.57, p=0.21) were not statistically significant between 2 cohorts.
IO-based therapies, particularly IO-TKIs, resulted in pathologic necrosis and reductions in tumor size prior to deferred CN. PFS and OS were similar for patients who received either upfront IO-based therapy or after CN.
Clinical genitourinary cancer. 2024 Jul 23 [Epub ahead of print]
Damla Gunenc, Wadih Issa, Thomas Gerald, Qinhan Zhou, Song Zhang, I Chidera Ibezue, Raj Bhanvadia, Isamu Tachibana, James Brugarolas, Hans Hammers, Qian Qin, Payal Kapur, Solomon Woldu, Kris Gaston, Yair Lotan, Jeffrey Cadeddu, Andrew Z Wang, Vitaly Margulis, Tian Zhang
University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX., University of Texas Southwestern, Department of Urology, Dallas, TX., Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX., University of Texas Southwestern, Department of Pathology, Dallas, TX., University of Texas Southwestern, Department of Radiation Oncology, Dallas, TX., University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX. Electronic address: .