Cytoreductive Nephrectomy Plus Active Surveillance Benefits Some With Metastatic Renal Cell Carcinoma

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Cytoreductive nephrectomy followed by active surveillance (CRN-AS) can yield favorable outcomes in certain patients with metastatic renal cell carcinoma (mRCC), according to research presented at the International Kidney Cancer Symposium (IKCS) 2021.

Patients who were classified as favorable risk by Rini criteria had better outcomes than patients classified as unfavorable risk, said Sari Khaleel, MD, of Memorial Sloan Kettering Cancer Center in New York, who presented this research at the meeting.

Dr Khaleel retrospectively reviewed patient data to determine whether CRN-AS may yield clinical benefits, depending on patient-specific prognosis.


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Data from 508 patients with mRCC were evaluated. All patients were systemic therapy-naive and underwent CRN. Among the 80% of patients with residual disease, 97 went on to AS.

The median follow-up for patients on AS was 31.8 months. The median intervention-free survival (IFS) was 11.6 months, and 58 patients (59.8%) ultimately went on to receive systemic therapy or surgery.

Overall, the AS patients had a median cancer-specific survival (CCS) of 56.5 months and a median overall survival (OS) of 52.3 months.

Patients who were classified as favorable risk by Rini criteria had a significantly longer median IFS than patients who were unfavorable risk — 17.1 months and 8.9 months, respectively (P =.026).

The median CSS was also significantly longer in favorable-risk vs unfavorable-risk patients — 71.4 months and 50.4 months, respectively (P =.041).

However, there was no significant difference in median OS between favorable-risk and unfavorable-risk patients — 66.7 months and 46.1 months, respectively (P =.12).

In a multivariate analysis, Charlson comorbidity index was a significant predictor of OS (P =.034) but not IFS or CSS. Sarcomatoid histology was a significant predictor of CSS (P =.02) but not IFS or OS. And Rini category was a significant predictor of IFS (P =.028) and CSS (P =.03) but not OS.

Disclosures: Dr Khaleel reported having no conflicts of interest.

Read more of Cancer Therapy Advisor’s coverage of IKCS 2021 by visiting the conference page.

Reference

Khaleel S. Outcomes of cytoreductive nephrectomy followed by active surveillance in metastatic renal cell carcinoma. Presented at IKCS 2021; November 5-6, 2021. Abstract N33.



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