The results from CARMENA, a randomised phase III clinical trial to assess the importance of surgery to remove the kidney (nephrectomy) in people with metastatic kidney cancer, have been re-analysed and were presented at the 2019 American Society of Clinical Oncology (ACSO) annual meeting in Chicago this week.

The original results showed that many people with metastatic kidney cancer can avoid nephrectomy without compromising survival. The median overall survival for people who received only sunitinib (a targeted therapy) was 18.4 months, compared to 13.9 months for those who received surgery followed by sunitinib, the current standard of care.

During the presentation, updated median follow-up data of 61.5 months was presented, and the analysis was re-run using the International Metastatic RCC Database Consortium (IMDC) risk groups.

The new analysis and additional follow-up data confirmed earlier findings from this trial, specifically that patients with poor-risk renal cell carcinoma (according to the IMDC criteria) had better overall survival with sunitinib treatment alone, compared to nephrectomy followed by sunitinib. However, in the intermediate-risk group of patients, there was no significant difference in overall survival between patients receiving sunitinib alone compared to nephrectomy followed by sunitinib. Also, the number of metastases did not correlate with overall survival outcomes. Lastly, those patients who had a nephrectomy after treatment with sunitinib tended to have longer overall survival than those who did not.

The authors concluded by saying that in the advent of combination treatments, the decision to use cytoreductive nephrectomy is becoming more complicated, especially since many patients receiving immunotherapy may obtain a complete response. They also suggested that delayed nephrectomies may play a greater role in the future as first-line treatments change from VEGF inhibitors to combination treatments. They finished by saying that the data presented during this talk supports delayed nephrectomy in patients who have a good response to initial therapy.

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