SUO 2017: Targeted Therapy Prior To Cytoreductive Nephrectomy For IMDC Intermediate And Poor Risk Patients

Washington, DC ( Introduction: Surgery for metastatic renal cell cancer (mRCC) with tumor thrombus is a complex procedure and pre-surgical targeted therapy may be used in patients who appear to have a limited life expectancy. The purpose of this study was to compare survival of patients with mRCC and thrombus treated with pre-surgical therapy prior to cytoreductive nephrectomy (CN) with those treated with upfront nephrectomy.

Methods: Comprehensive data was reviewed for 486 mRCC patients with tumor thrombus treated surgically from 2000 to 2015 at five centers. Patients were divided into two groups: pre-surgical therapy and upfront nephrectomy. Patients were stratified using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria into risk groups and overall survival (OS) compared using the Kaplan Meier method.

Results: There were 39 patients in the pre-surgical therapy group (pre-surgical +CN; N=39; 8.0%); and 447 patients in the upfront CN group (upfront CN; n=447; 92%).Thrombus level was 0,1,2,3, and 4 in 131(29.3%), 59(13.1%), 154(34.4%), 61(13.6%) and 42 (9.4%) in upfront nephrectomy group and 13 (13.3%), 10 (25.6%), 9 (23.1%), 5(12.8%) and 2 (5.1%) in pre-surgical therapy group. After risk stratification, 26/39 (66.6%) pre-surgical therapy and 209/387 (54.0%) upfront nephrectomy patients were IMDC intermediate risk. Median OS (IQR) was not different for pre-surgical therapy; 26.2(13.1-na) months vs upfront nephrectomy; 24.6(9.9-50.1) months for IMDC intermediate risk patients, (p=0.36). A total of 13/39 (33%) pre-surgical therapy and 178/387(45%) upfront nephrectomy patients were IMDC poor risk. Median OS (IQR) was not different for pre-surgical therapy group; 38.1 months (10.1-49.4) vs. upfront nephrectomy group; 13.4 months (5.1-33.8) for IMDC poor risk patients, (p=0.28).

Conclusion: No difference was identified in OS for patients who received pre-surgical targeted therapy prior to CN compared to upfront CN. Additional studies are required to evaluate the optimal patient selection for pre-surgical therapy in mRCC patients with thrombus.

Presented by: Shivashankar Damodaran, Madison, Wisconsin, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC