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 complications. Recent studies have questioned the role of cytoreductive nephrectomy for patients with RCC that has spread (metastatic RCC).

Metastatic sarcomatoid/rhabdoid clear cell RCC is an aggressive type of RCC that responds well to treatment with immunotherapy (immune checkpoint inhibitors). However, the role of cytoreductive nephrectomy for these types of RCC has not been investigated before. This presentation looks at the survival outcomes in patients with metastatic sarcomatoid/rhabdoid RCC treated with cytoreductive nephrectomy followed by immune checkpoint inhibitors.

The records of patients with metastatic sarcomatoid/rhabdoid RCC at one large cancer centre in America were reviewed. Ninety-one (91) of these patients were treated with an immune checkpoint inhibitor. Most patients (79%) had more than one site of cancer spread and nearly 60% had intermediate risk disease. Three quarters of patients were given an immune checkpoint inhibitor as their first medicine, mostly the nivolumab plus ipilimumab combination or an immune checkpoint (PD-1) inhibitor on its own. Patients who had a delayed or an upfront cytoreductive nephrectomy had longer overall survival time on immune checkpoint inhibitor treatment than those without a nephrectomy (29 months compared to 14 months, respectively).

This review suggests that cytoreductive nephrectomy might improve survival for patients with sarcomatoid/rhabdoid RCC taking immune checkpoint inhibitors and can be considered in selected patients. Due to the retrospective character of this study, results must be interpreted carefully.

Watch the video on Practice Update here