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Surgery to remove the kidney tumour is often the preferred treatment for people with kidney cancer that has not spread. Recently, doctors have been questioning whether it is beneficial to operate to remove the kidney tumour in patients with kidney cancer that has already spread beyond the kidney.
Immunotherapies for advanced kidney cancer include drugs such as nivolumab, ipilimumab, avelumab and pembrolizumab. These drugs work by releasing the ‘brakes’ on the immune system allowing the immune system to kill the cancer cells. These immune checkpoint inhibitor drugs are sometimes given in combination with targeted therapies that block the blood supply to the tumour. Many researchers and oncologists have questioned whether the risks and downsides of invasive surgery can be justified for today’s patients who have access to these new, and sometimes more effective medicines.
At the American Society for Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium 2020 in San Francisco on 13-15 February, researchers from a large international research team known as the International Metastatic RCC Database Consortium (IMDC) presented data from people across the world to see whether surgery to remove the kidney tumour improved the lives of people taking immune checkpoint inhibitors.
They found that surgery was associated with improved survival in patients who took immune checkpoint inhibitors. However, the team stressed that these results do not apply to all patients with advanced kidney cancer. People taking immune treatment and surgery together are likely to be younger and have less medical problems. Because this was not a controlled study, these findings should be interpreted with caution. Patients should decide very carefully if they are offered surgery, and in general, cancer medicines should be prioritised.