Investigators identified a subgroup of patients with metastatic renal cell carcinoma (mRCC) who do not need immediate systemic therapy and may benefit from upfront cytoreductive nephrectomy (CN), according to a presentation at the European Association of Urology 2020 virtual congress.
The subgroup includes patients with low metastatic load (oligometastatic disease), lung-only metastases, and 2 or fewer modified International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria, Eduard Roussel, MD, of University Hospitals Leuven in Leuven, Belgium, and colleagues concluded. These characteristics, respectively, were significantly associated with a 67%, 52%, and 44% decreased likelihood of requiring systemic therapy.
Dr Roussel’s team studied 205 patients divided into cohorts A and B. Cohort A included 86 surgical patients undergoing cytoreductive nephrectomy (CN) who were studied to identify morbidity predictors. Cohort B, which had 119 patients, compared outcomes in 3 subgroups: patients undergoing CN immediately followed by treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs [CN>TKI subgroup]); those undergoing CN followed by a therapy-free interval (watchful waiting) of at least 6 months (CN>WW subgroup); and those treated with VEGFR-TKIs alone (TKI Only subgroup).
Median overall survival (OS) was similar in the CN>TKI and TKI only subgroups but substantially longer in the CN>WW subgroup (17, 13, and 56 months, respectively), Dr Roussel’s team reported. Oligometastatic disease, lung as the only metastatic site, and having 2 or fewer modified IMDC criteria predicted systemic therapy-free survival following diagnosis.
Dr Roussel and his collaborators noted that patients in the CN>WW subgroup had better OS than patients included in the CARMENA phase 3 trial, which compared the TKI sunitinib alone and CN followed by sunitinib in patients with intermediate- and poor-risk mRCC. In that trial, median OS did not differ significantly between the groups (18.4 vs 13.9 months, respectively).
In cohort A of the present study, 42% of patients experienced a surgery-related complication, with 2.3% having a high-grade complication. Estimated blood loss predicted complications of any grade and preoperative C-reactive protein levels predicted high-grade complications, according to the investigators.
Roussel E, Verbiest A, Milenkovic U, et al. The role of cytoreductive nephrectomy in the contemporary management of metastatic kidney cancer: predictive factors for surgical complications and oncological survival. Presented at: EAU20 Virtual Congress; July 17 to 19, 2020. Abstract 838.
Méjean A, Ravaud A, Thezenas S, et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med. 2018;379:417-427.