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AUA 2021: Immunotherapy and Cytoreductive Nephrectomy in Metastatic Kidney Cancer

By: Vanessa A. Carter, BS
Posted: Monday, September 20, 2021

During the 2021 American Urological Association (AUA) Annual Meeting, Sarah Psutka, MD, of the University of Washington School of Medicine, Seattle, and colleagues presented their research on the survival outcomes of patients with metastatic renal cell carcinoma who received immune checkpoint inhibitor therapy with or without cytoreductive nephrectomy (Abstract MP14-08). Their results demonstrated improved overall survival in patients who underwent nephrectomy versus those given standard therapy alone.

“Although this retrospective study is subject to significant imbalances in prognostic factors, these results support research to identify predictors for improved outcomes with cytoreductive nephrectomy and the potential utility of cytoreductive nephrectomy in carefully selected patients,” the investigators stated.

The data on 367 patients diagnosed with metastatic renal cell carcinoma and treated with immune checkpoint inhibitors with (n = 231) or without (n = 136) cytoreductive nephrectomy were retrospectively reviewed. More than half (54.5%) of patients received immune checkpoint inhibitors as a third or subsequent line of therapy, followed by front-line (28.1%) and second-line (17.4%) administration. In both groups with and without nephrectomy, 65.4% of patients had intermediate-risk disease, according to the International Metastatic Renal Cell Carcinoma Database Consortium risk classification; 16.5% versus 29.4% of participants were at poor risk, and 5.6% versus 2.9% were at favorable risk, respectively. Individuals who underwent cytoreductive nephrectomy had surgery at a median of 0.9 months after diagnosis.

The median overall survival for patients who had surgery was 56 months, versus 19 months for those given standard therapy alone. Individuals who underwent nephrectomy had a shorter median time from diagnosis to the administration of immune checkpoint inhibitor therapy, and 19.2% of these patients achieved a complete response, whereas no patients given standard therapy alone did. Participants in the nephrectomy group also had higher rates of partial response (27.6% vs. 26.8%) and stable disease (23.4% vs. 17.9%), and individuals who did not undergo surgery more often experienced progressive disease (19.2% vs. 32.1%).

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