Nephrectomy as Initial mRCC Treatment Offers Survival Advantage

Patients who underwent upfront cytoreductive nephrectomy lived 6.4 months longer than those treated with upfront targeted therapy, a study found.
Patients who underwent upfront cytoreductive nephrectomy lived 6.4 months longer than those treated with upfront targeted therapy, a study found.

Cytoreductive nephrectomy (CN) offers a survival advantage over targeted therapy as initial treatment for clear-cell metastatic renal cell carcinoma (mRCC), researchers reported at the 2016 Genitourinary Cancers Symposium in San Francisco.

A team led by Liam C. Macleod, MD, MPH, of the University of Washington School of Medicine in Seattle, noted that previous randomized trials have demonstrated a survival benefit for upfront CN preceding immunotherapy, but it is unclear whether this survival benefit persists in the targeted therapy era.

Dr. Macleod and his colleagues studied 492 clear-cell mRCC patients using 2006–2011 data from the Surveillance, Epidemiology, and End Results (SEER) registries. The cohort included 227 patients who received upfront CN and 265 who received upfront targeted therapy. The investigators identified targeted therapy from Medicare Part D claims.

The median survival time was significantly longer in the upfront CN than the upfront targeted therapy group (18 vs. 10 months). In adjusted analyses, upfront targeted therapy was associated with a 70% increased risk of death compared with upfront CN. A propensity matched analysis showed that upfront CN was associated with a significant 6.4 month survival advantage, according to the researchers.

“We attempt to account for a number of factors affecting treatment selection bias, and do find improved overall survival among those [patients] receiving cytoreductive nephrectomy,” Dr. Macleod told Renal & Urology News. “These findings will need to be placed in context with upcoming clinical trials examining the role of surgery relative to sunitinib in the mRCC setting.”

The symposium is sponsored by the American Society of Clinical Oncology, American Society for Radiation Oncology, and the Society of Urologic Oncology.

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