Surgical complications from cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) are similar regardless of whether patients receive sunitinib before or after the procedure, according to findings from the SURTIME published in European Urology.
In the randomized controlled trial of 99 patients, investigators compared deferred CN (3 cycles of presurgical sunitinib, a vascular endothelial growth factor receptor tyrosine kinase inhibitor [VEGFR-TKI], followed by CN 24 hours after the final dose) with upfront CN. In the deferred CN group, primary tumor diameter decreased by 13.8% and all tumors were resectable, Axel Bex, MD, PhD, of Royal Free London NHS Foundation Trust, and colleagues reported. Just 2 patients receiving upfront sunitinib had to delay CN for more than 2 weeks.
The same proportion of patients in the immediate and deferred CN groups had surgery-related adverse events (AEs): 52% vs 53%, respectively. More intraoperative AEs occurred in the immediate CN arm, however. With respect to postoperative events, 6.5%, 13%, and 4.3% of the immediate CN group and 2.5%, 7.5%, and 2.5% of the deferred CN group experienced Clavien-Dindo grade 3 or higher complications, readmission within 30 days, and in-hospital mortality, respectively. The team observed no differences in operative time, blood loss, and hospital length of stay.
These results contrast with previous retrospective studies describing intraoperative adhesions, difficulties with dissection, wound healing problems, and a higher postoperative complication rate after presurgical VEGF-targeted therapy, the team noted.
Dr Bex and his peers acknowledged that their study results should be interpreted with caution due to the small size of the cohort. They urged future research to confirm the findings.
This study was funded by Pfizer and Kankerbestrijding/KWF in the Netherlands.
Emile De Bruijn R, Mulders P, Jewett MA, et al. Surgical safety of cytoreductive nephrectomy following sunitinib: Results from the Multicentre, Randomised Controlled Trial of Immediate Versus Deferred Nephrectomy (SURTIME). Eur Urol. doi:10.1016/j.eururo.2019.06.006