Results of the phase 3 SURTIME trial comparing pretreatment with sunitinib before nephrectomy, with immediate nephrectomy followed by sunitinib treatment were published in JAMA Oncology recently.
The findings suggest that pretreating metastatic renal cell carcinoma (RCC) patients with sunitinib before surgery may lead to better or at least similar outcomes for patients compared to immediate nephrectomy. Although the patients who were pretreated with sunitinib before surgery had a longer overall survival (OS) compared with those who received immediate nephrectomy, these same patients were also more likely to receive sunitinib therapy (98% versus 80%).
However, the trial was small and underpowered, and it was only able to observe a benefit of deferring nephrectomy in terms of overall survival as a secondary endpoint (rather than a primary endpoint). The primary endpoint of progression-free survival was similar for both groups of patients (43% for sunitinib pretreated, 42% for immediate nephrectomy).
It is not clear why the pretreated patients had improvements in overall survival but not progression-free survival, but it may be because progression-free survival, especially beyond the first several months, does not necessarily correlate with extent of progression and death from the disease, said the researchers.