CYTOREDUCTIVE NEPHRECTOMY STILL BENEFICIAL IN METASTATIC RENAL CANCER?

NEW YORK (Reuters Health) Mar 12 - Even when patients with metastatic renal cancer are treated with vascular endothelial growth factor (VEGF)-targeted agents, cytoreductive nephrectomy still improves survival, according to study findings presented earlier this month at the Genitourinary Cancers Symposium in San Francisco.

"This is the first study to look at the value of debulking nephrectomy...in the new era of VEGF-targeted agents," lead researcher Dr. Toni K. Choueiri, from Dana-Farber Cancer Institute, Boston, told Reuters Health by email. The "standard is to take the kidney out in stage IV disease if technically possible and the patient is fit for surgery, but the info comes from the era of interferon therapy, which is not used anymore."

The new findings are from a review of data on 314 patients with renal cell carcinoma who received an anti-VEGF agent - either sunitinib, sorafenib, or bevacizumab. Of these patients, 201 also had cytoreductive nephrectomy; the other 113 served as controls

Patients in the cytoreductive nephrectomy were mor likely to be younger than 60 years, to have more than one site of metastasis and to have impaired renal function. Patients in the control group were more likely to have a diagnosis to treatment time of less than 1 year, a Karnofsky performance score of less than 80, to receive sunitinib and to have an elevated calcium level.

On univariate analysis, cytoreductive nephrectomy was tied to a median overall survival period of 19.8 months, more than double the 9.4 months seen in the control group (HR, 0.44, p <>

After accounting for known prognostic factors in patients treated with anti-VEGF agents, cytoreductive nephrectomy was still associated with a significant improvement in overall survival (HR, 0.68, p = 0.04).

In intermediate risk patients, cytoreductive nephrectomy reduced the risk of death during follow-up by 54% (p = 0.004). In subjects with a Karnofsky score >80, median overall survival increased from 14.5 to 23.9 months with use of this procedure (p = 0.003).

By contrast, patients in poor risk groups or those with a low Karnofsky score derived minimal benefit from cytoreductive nephrectomy.

The limitations of the current study include its retrospective design and the lack of central pathologic review, Dr. Choueiri said.

Dr. Choueiri also said a randomized phase III trial (CARMENA) is underway that compares the outcomes of patients treated with sunitinib alone or followed by cytoreductive nephrectomy.