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Surgery to remove the kidney and tumour (nephrectomy) has an important role as a standard therapy in the treatment of metastatic kidney cancer. However, in recent years immunotherapy combinations have become standard anti-cancer treatment, and the role of nephrectomy in metastatic kidney cancer is unclear. This study looks at the impact of nephrectomy on survival in patients with metastatic kidney cancer who are treated with immunotherapy plus targeted therapy combinations.
There were 165 patients in the study, 97 of which had a nephrectomy. All patient were treated with immunotherapy plus targeted therapy combinations. Patients were followed up for just over 2 years. Those patient who had a nephrectomy had a longer time to when the treatment stopped working and the cancer started growing again compared to patients treated with an immunotherapy-targeted therapy combination alone (average progression-free survival of 14.4 months versus 10.8 months, respectively). At one year, more patients survived without progression of their disease if they had a nephrectomy (60.8%) compared to those who did not have a nephrectomy (30.9%). Also, more patients responded to treatment if they had a nephrectomy compared to those who did not have a nephrectomy (60.8% and 52.9%, respectively), and the cancer was better controlled in those patients who had nephrectomy.
The most common side effects to treatment were problems with the thyroid gland (hypothyroidism), immune-related inflammation of the lungs and rash.
This study showed that nephrectomy in addition to an immunotherapy plus targeted therapy combination may give patients a survival benefit compared to immunotherapy plus targeted therapy combinations alone.