Cytoreductive Nephrectomy Benefits Select mRCC Patients Taking TT

Among patients treated with targeted therapy, overall survival was 17.1 months for CN recipients vs 7.7 months for those without CN.
Among patients treated with targeted therapy, overall survival was 17.1 months for CN recipients vs 7.7 months for those without CN.

SAN DIEGO—Certain patients with metastatic renal cell carcinoma (mRCC) taking targeted therapy (TT) enjoy a survival benefit when cytoreductive nephrectomy (CN) is added, according to new research presented at the 2016 American Urological Association meeting.

Recent reports show declining use of CN in the TT era. So a team led by Nawar Hanna, MD, of Brigham and Women's Hospital in Boston, used the 2006–2013 data from National Cancer Data Base to compare overall survival in 12,995 mRCC patients taking TT, based on who did and did not receive CN. They also looked at predictors of CN using an all-inclusive group of 15,390 patients.

Results showed that 3 out of 10 patients with mRCC treated with TT undergo CN. After analysis, the investigators determined that patients having CN tended to be younger, obtain care at an academic center, and have lower Charlson Comorbidity Index scores. Their cancers were more likely to be a lower primary tumor stage and without lymph node involvement.

Survival was better for patients who underwent CN and TT, compared with TT alone, according to multivariable Cox regression analysis. Overall survival was 17.1 months for CN patients compared with 7.7 months for those without CN, on median. The incremental survival benefit was 0.7, 1.8, 2.8, and 3.6 months for patients who survived up to 6, 12, 18, and 24 months, respectively.

“Even in the targeted therapy era, cytoreductive nephrectomy in addition to targeted therapy is associated with a survival benefit in patients with metastatic renal cell carcinoma,”Dr Hanna told Renal & Urology News. “A careful patient selection remains warranted.”

Important questions still need to be answered with future research, he added, including what the ideal timing of CN is in relation to TT and how newly introduced immunotherapy will be incorporated.

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