Surgery after targeted therapy or immunotherapy for metastatic kidney cancer

A recent retrospective study (looking back at the patients’ cases after treatment had occurred) has shown that patients with metastatic renal cell carcinoma (RCC) who were treated with targeted therapy, such as sunitinib or pazopanib, or immunotherapy, such as nivolumab, had better survival outcomes if went on to have surgery to remove the kidney. This is called neoadjuvant treatment.

There were 4,639 patients with metastatic RCC in the trial and who were treated with either immune checkpoint inhibitor or targeted therapy. A total of 4,202 patients were on a targeted therapy. Of these patients, 2,631 had nephrectomy while 1,571 did not. Meanwhile, 437 of the patients were on immune checkpoint inhibitors, 245 of whom had nephrectomy while 192 did not. The data came from more than 40 centres across the world.

The patients were followed for an average of 38.5 months. Patients who were treated with targeted therapy before they had their nephrectomy experienced an average overall survival of 26.5 months versus 10.3 months in those who did not have nephrectomy.

Patients who had immune checkpoint inhibitor treatment before nephrectomy had an average overall survival of 53.6 months versus 21.4 months for patients who were not on neoadjuvant immunotherapy.

However, not every patient with metastatic RCC will benefit from nephrectomy followed by targeted treatment or immunotherapy. Some studies, such a the CARMENA trial found that patients who had one risk factor (such as low haemoglobin or high calcium levels) benefited from surgery before receiving sunitinib, especially if they had only one site of disease spread.

Read more in Cure here