CYTOREDUCTIVE NEPHRECTOMY IN THE ERA OF TKIs-MAY BE USEFUL

In a National Cancer Data Base study reported in the Journal of Clinical Oncology, Hanna et al found that cytoreductive nephrectomy may improve survival in patients receiving targeted therapy for metastatic renal cell carcinoma.

Study Details

The study involved data from 15,390 patients treated with targeted therapy between 2006 and 2013; of them, 5,374 (35%) underwent cytoreductive nephrectomy. Those undergoing nephrectomy were significantly more likely to be younger, privately insured, treated at an academic center, and have a lower tumor stage and cN0 disease.

Survival Outcomes

Median overall survival was 17.1 months in patients undergoing cytoreductive nephrectomy vs 7.7 months in those not undergoing nephrectomy (P < .001). In multivariate analysis including age, sex, race, Charlson comorbidity index, education, income, insurance, type and location of facility, cT stage, cN stage, year of diagnosis, histology, Fuhrman grade, and metastasectomy status, the hazard ratio (HR) for nephrectomy vs no nephrectomy was 0.49 (P < .001).

In a sensitivity analysis using adjusted propensity scores in addition to other covariates, the hazard ratio was 0.45 (P <. 001). The incremental survival benefit was 0.7, 1.8, 2.8, and 3.6 months in patients surviving ≤ 6, 12, 18, and 24 months (all P < .001), respectively.

The investigators concluded: “[Cytoreductive nephrectomy] is performed in three of 10 patients with [metastatic renal cell carcinoma] who are receiving [targeted therapy]. Several patient and sociodemographic characteristics were associated with receipt of [cytoreductive nephrectomy]. When feasible, [cytoreductive nephrectomy] may offer an [overall survival] benefit when combined with [targeted therapy].”

The study was supported by the Quebec Urological Association, Trust family, Loker Pinard, Michael Brigham Funds for Kidney Cancer Research at Dana-Farber Cancer Institute, and Dana-Farber/Harvard Cancer Center Kidney Cancer Program.

Toni K. Choueiri, MD, of Dana-Farber Cancer Institute, Boston, is the corresponding author of the Journal of Clinical Oncology article.