IKCS 2021: Outcomes of Cytoreductive Nephrectomy Followed by Active Surveillance in Metastatic RCC

(UroToday.com) In the Top Abstracts session of the 2021 International Kidney Cancer Symposium (IKCS): North America meeting, Dr. Khaleel presented their work examining outcomes for patients with metastatic renal cell carcinoma (mRCC) treated with initial cytoreductive nephrectomy followed by active surveillance.

By way of background, Dr. Khalell highlighted that the role of cytoreductive nephrectomy is controversial in the contemporary care of patients with metastatic renal cell carcinoma (mRCC). However, systemic therapy is associated with a high rate of grade 3 and 4 adverse events, up to 50% in patients receiving immunotherapy and more than 50% of patients treated with VEGF inhibitors. Thus, up front cytoreductive nephrectomy followed by active surveillance is a valid treatment approach. He cited three studies demonstrating the potential for active surveillance to delay the initiation systemic therapy.

In particular, he highlighted work from Dr. Brian Rini and colleagues who observed a cohort of patients with treatment-naïve oligometastatic mRCC. The vast majority (98%) had prior nephrectomy. The median surveillance period was 14.9 months. They further identified two predictors of prolonged periods of surveillance: one or fewer IMDC risk factors and two or fewer metastatic organ sites.

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In the present analysis, they included 97 patients who understand cytoreductive nephrectomy followed by active surveillance. These patients were derived from an initial cohort of 508 patients who were systemic therapy naïve and underwent cytoreductive nephrectomy.

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These authors assessed the primary outcome of intervention free survival, with intervention defined as systemic therapy or focal therapy (surgery or radiotherapy). Secondary outcomes included cancer-specific and overall survival. Subgroup analyses were performed according to Rini criteria as detailed above.

Compared to those who received cytoreductive nephrectomy and systemic therapy, those who received cytoreductive nephrectomy and surveillance were older, with smaller tumors, less frequent sarcomatoid features, lower stages of disease, and less common nodal and bony metastases.

Over a median follow-up of 32 months, the median intervention-free survival was 11.6 months. Median overall survival was 52.3 months and median cancer-specific survival was 56.5 months. Notably, the Rini criteria appeared to be able to stratify patients, with significantly longer median intervention free survival and cancer specific survival among those with Rini favourable disease.

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In conclusion, this study demonstrated that cytoreductive nephrectomy followed by active surveillance is a reasonable treatment approach in properly selected patients.

Presented by: Sari Khaleel, MD MSc, Minnesota


Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD during the International Kidney Cancer Symposium (IKCS) 2021 Annual Congress, November 5 and 6, 2021.

 

 

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