Cytoreductive nephrectomy for the treatment of metastatic renal cell carcinoma is independently associated with longer overall survival (OS) in patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors in any line of therapy, compared to patients who did not undergo cytoreductive nephrectomy, according to study findings.

“Cytoreductive nephrectomy for the treatment of metastatic renal cell carcinoma was called into question following the publication of the CARMENA trial,” wrote study authors. “While previous retrospective studies have supported [cytoreductive nephrectomy] alongside targeted therapies, there is minimal research establishing its role in conjunction with immune checkpoint inhibitor therapy.”

This multicenter, retrospective cohort study included 367 patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitor systemic therapy at any point in their disease course at the Seattle Cancer Care Alliance, and The Ohio State University between 2000 and 2020. There were 232 patients who underwent cytoreductive nephrectomy in addition to systemic therapy, and 135 patients who received systemic therapy alone.

For 28.1% of the patients, immune checkpoint inhibitors were given in the first line, 17.4% in the second line, and 54.5% in the third or subsequent line. Of those undergoing cytoreductive nephrectomy, 30 were deferred. The primary end point was OS.

The median follow-up duration was 28.4 months. The median OS of patients who underwent both cytoreductive nephrectomy and systemic therapy was 56.3 months, compared to 19.1 months in those who underwent systemic therapy alone.

According to multivariable analyses, there was a 67% reduction in risk of all-cause mortality in patients who received cytoreductive nephrectomy with systemic therapy compared to systemic therapy alone (P <.0001). These results were similar in the subgroup of patients who received immune checkpoint inhibitors in the first line. There were no significant differences in OS between patients who received upfront cytoreductive nephrectomy and those who deferred.

The study authors concluded, “our data support consideration of [cytoreductive nephrectomy] in well selected patients with [metastatic renal cell carcinoma] undergoing treatment with [immune checkpoint inhibitors].”

Source:

Gross EE, Li M, Yin M, et al. A multicenter study assessing survival in patients with metastatic renal cell carcinoma receiving immune checkpoint inhibitor therapy with and without cytoreductive nephrectomy. Urol Oncol. Published online October 26, 2022. doi:10.1016/j.urolonc.2022.08.013