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The role of pre-cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) in the era of immune checkpoint inhibitor therapy is unclear
.
Recently, researchers from the United States published an article in Eur Urol investigating the relationship between prior CN and clinical outcomes in mRCC patients receiving immune checkpoint inhibitors or targeted therapy.
Using the International Metastatic RCC Database, the researchers identified patients diagnosed with new-onset mRCC who were either receiving immune checkpoint inhibitors or targeted therapy
.
The researchers compared overall survival (OS) between the two groups
using the Kaplan-Meier method and the multivariate Cox regression method that adjusted for known prognostic factors.
The researchers included a total of 4639 eligible mRCC patients
.
Of the 4202 patients who received targeted therapy and 437 patients who received immune checkpoint inhibitors, 2326 (55%) and 234 (54%) patients received pre-CN
prior to the start of treatment.
In multivariate analyses, CN was associated
with better OS in both the immune checkpoint inhibitor treatment group (hazard ratio [HR]: 0.
61; 95% confidence interval [CI], 0.
41 to 0.
90, p=0.
013) and the targeted therapy group (HR: 0.
72; 95% CI, 0.
67 to 0.
78, p<0.
001).
There was no difference in OS benefit for CN between immune checkpoint inhibitors and targeted therapy groups (interaction p=0.
6).
Limitations of the study included patient selection in large academic centers and the retrospective nature
of the study.
OS situation with or without CN
In summary, in selected patients receiving immune checkpoint inhibitors or targeted therapy, upfront CN is associated
with a clear OS benefit.
Therefore, in the era of immune checkpoint inhibitors, CN still has an effect
on specific patients.
Original source:
Ziad Bakouny， Talal El Zarif， Shaan Dudani et al.
Upfront Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors or Targeted Therapy： An Observational Study from the International Metastatic Renal Cell Carcinoma Database Consortium.
Eur Urol.
Oct 2022
