Cytoreductive Nephrectomy, Immunotherapy-Based Systemic Therapy Induce Benefit in mRCC

Article

A pooled analysis compared survival among patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy and either targeted therapy or immunotherapy regimens utilizing checkpoint inhibitors.

Patients with metastatic renal cell carcinoma (mRCC) who underwent cytoreductive nephrectomy experienced improved survival when treated with either targeted therapy or immunotherapy, according to research presented at the 21st Annual Meeting of the Society for Urologic Oncology.1

In particular, patients treated with systemic immunotherapy derived the greatest benefit.

The investigators assessed the effect of cytoreductive nephrectomy by searching PubMed and conference proceedings of relevant medical societies to identify observational cohort studies for patients receiving either targeted therapy or immunotherapy.

The primary objective of the study was to assess the benefit of cytoreductive nephrectomy relative to the newer area of immunotherapy regimens utilizing checkpoint inhibitors.

Studies were limited to those where the investigators were able to identify analyses of the effect of cytoreductive nephrectomy in patients receiving targeted therapy and immunotherapy from the same dataset.

From the 280 search results, 3 relevant studies were identified. Two studies reported comparisons of cytoreductive nephrectomy with systemic therapy and systemic therapy alone using the Nation Cancer Database, while the third utilized the International Metastatic RCC Database Consortium.

A pooled analysis of these studies indicated that there was improved survival with cytoreductive nephrectomy in both the targeted therapy cohorts (n = 2; HR, 0.52; 95% CI, 0.46-0.59; I2 = 80%) and the immunotherapy cohorts (n = 2; HR, 0.28; 95% CI 0.16-0.49; I2 = 21%), with a significantly stronger association in the immunotherapy groups (P = 0.04; I2 = 77%).

The value of cytoreductive nephrectomy was called into question following the results of the CARMENA trial, which failed to demonstrate a benefit of cytoreductive nephrectomy among patients receiving sunitinib (Sutent).2

While that trial showed that patients receiving sunitinib alone had superior overall survival to those patients receiving cytoreductive nephrectomy plus sunitinib (27.9 months vs 19.0 months; HR, 0.95; 95% CI, 0.70–1.24), researchers at the time noted that the combination approach might still be applied to select subgroups of patients.

While the current study was limited to observational data, the investigators believed the results of the CARMENA trial do not preclude a benefit of cytoreductive nephrectomy for patients when combined with current immunotherapy-based regimens.

They noted that ongoing studies specifically evaluating cytoreductive nephrectomy in combination with immunotherapy-based treatment should help clarify the role of cytoreductive nephrectomy in current practice settings.

References

  1. Hall ME, Bhindi B, Luckenbaugh AN, et al. Cytoreductive nephrectomy: are conclusions from the targeted therapy era valid in the checkpoint inhibitor era? Presented at: 21st Annual Meeting of the Society for Urologic Oncology; December 3, 2020. Poster 85.
  2. Lawrence L. Carmena Trial: Should Nephrectomy Be Standard for Metastatic RCC? CancerNetwork. June 10, 2019. https://www.cancernetwork.com/view/carmena-trial-should-nephrectomy-be-standard-metastatic-rcc. Accessed December 3, 2020.
Recent Videos
One of the largest obstacles to tackle in the kidney cancer landscape will be translating the research on rare kidney cancer subtypes into clinical trials.
Zanzalitinib exhibited favorable data when evaluated alone or in combination with anti-PD-1 immune checkpoint inhibition in phase 1 RCC trials.
The investigational agent exhibited superior efficacy vs pembrolizumab in patients with lung cancer, suggesting potential efficacy in kidney cancer.
“As a community, if we’re looking to help enroll and advocate for patients with rare [kidney cancers], we need to be aware of what is out there,” said A. Ari Hakimi, MD.
Treatment with the dual inhibitor displayed a short half-life and a manageable toxicity profile in patients with clear cell renal cell carcinoma.
The annual Kidney Cancer Research Summit was born from congressional funding for kidney cancer research, according to KidneyCAN president Bryan Lewis.
Combining renal vaccines with immune therapy may better target tumor cells while limiting harm to healthy tissue, according to David A. Braun, MD, PhD.
Improving data collection and biomarker development across institutions may represent areas of expansion in kidney cancer research.
KIM-1 is a biomarker in the blood that may help noninvasively detect kidney cancer, according to Wenxin (Vincent) Xu, MD.
A phase 0 trial is seeking to assess the feasibility of aiding anti-cancer cells with cytokines to restore their function.
Related Content