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Cytoreductive nephrectomy is the surgical removal of the tumour to reduce the number of cancer cells (tumour burden), reduce the symptoms and immunosuppression caused by the tumour, and prevent medical complications, an important consideration for patients with advanced RCC. This study presented at the ASCO GU Symposium looked at the use of cytoreductive nephrectomy followed by combination immunotherapy in patients with kidney cancer lung metastases.
This real-world study included 1084 patients with metastatic RCC who had received treatment with a first-line immunotherapy combination (either two immunotherapies, or an immunotherapy plus a VEGF TKI) for the treatment of lung metastases. Most patients (84%) had intermediate or poor risk disease.
Of the 898 patients who had scans, 4% had a complete response to treatment, 38% had a partial response, 35% had stable disease, and 23% had progressive disease following first-line treatment with an immunotherapy combination. Average overall survival time for the patients with a complete response was not reached. However, for those who had a partial response it was 56 months, 48 months for those with stable disease and 13 months for those with progressive disease.
Those patients who had lung metastases and cytoreductive nephrectomy had a higher chance of cancer shrinkage with first-line immunotherapy combinations. Also, the likelihood of response to first-line immunotherapy was significantly higher in patients who had favourable-risk disease.
In conclusion, patients with lung metastases who had cytoreductive nephrectomy were more likely to respond to first-line treatment with immunotherapy combinations. Also, patient with favourable-risk RCC were more likely to benefit from cytoreductive nephrectomy followed by combination immunotherapy. Other factors, such as sex, age, sarcomatoid histology, smoking status, and presence of liver or brain metastases, were not significantly associated with response. Additional analyses are planned to evaluate the effect of clinical variables on overall survival.