ESMO 2017: Timing of Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma
Axel Bex, MD, PhD, of The Netherlands Cancer Institute of Amsterdam, and colleagues evaluated the efficacy of immediate versus deferred cytoreductive nephrectomy with sunitinib for patients with metastatic renal cell carcinoma. The results, which were presented at the 2017 European Society for Medical Oncology (ESMO) Congress (Abstract LBA35), suggest that the sequence of cytoreductive nephrectomy and sunitinib does not affect progression-free rates at 28 weeks. However, the rates of overall survival and postoperative complications seemed to favor deferred over immediate cytoreductive nephrectomy.
A total of 99 patients with advanced kidney cancer were randomized to undergo treatment with immediate surgery followed by sunitinib (n=50) versus three cycles of sunitinib prior to surgery plus sunitinib (n=49). Patients had a histologically confirmed clear cell subtype and a resectable asymptomatic primary tumor plus few surgical risk factors.
The progression-free rate was 42.0% for those who had immediate surgery and 42.9% for those who had deferred surgery. The median overall survival was 32.4 months and 15.1 months for the deferred and immediate arms, respectively. The investigators noted, however, that the sample size makes it difficult to determine definitive conclusions.