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Does Sunitinib Therapy Before Cytoreductive Nephrectomy Improve Outcomes in Metastatic Kidney Cancer?

By: Joseph Fanelli
Posted: Monday, January 21, 2019

Deferring cytoreductive nephrectomy for sunitinib therapy in patients with renal cell carcinoma did not appear to ward off disease progression, according to results from the randomized SURTIME clinical trial published in JAMA Oncology. However, Axel Bex, MD, PhD, of The Netherlands Cancer Institute, and colleagues did report that patients who were pretreated with sunitinib reported better overall survival.

“Pretreatment with sunitinib may identify patients with inherent resistance to systemic therapy before planned cytoreductive nephrectomy,” the authors concluded. “These data suggest that performing deferred cytoreductive nephrectomy in patients with non-progressing disease may confer a survival benefit instead of limiting cytoreductive nephrectomy to only the few patients who need surgery after treatment with sunitinib alone.”

The researchers randomly assigned 99 patients with metastatic renal cell carcinoma to undergo either immediate cytoreductive nephrectomy followed by sunitinib (50 patients) or 3 cycles of sunitinib followed by deferred cytoreductive nephrectomy if the disease had not progressed (49 patients). Sunitinib was administered at a dose of 50 mg/d for 4 weeks followed by 2 weeks rest. All but one patient who deferred cytoreductive nephrectomy received presurgical sunitinib, and 83% received the requisite 3 cycles prior to surgery.

The 28-week progression-free rate was 43% in patients who received sunitinib before cytoreductive nephrectomy and 42% in those who received cytoreductive nephrectomy after the targeted agent. The overall survival hazard ratio of deferred versus immediate cytoreductive nephrectomy was 0.57, with a median overall survival of 32.4 months in the deferred group and 15.0 months in the nondeferred group.

Disclosure: The study author’s disclosures can be found at jamanetwork.com.



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