Combining cytoreductive nephrectomy (CN) with immune checkpoint inhibitor (ICI) therapy can prolong overall survival, compared with ICI therapy alone, in patients with metastatic renal cell carcinoma (mRCC), according to research published in Urologic Oncology.
The median overall survival was 56.3 months for patients who received CN plus ICI therapy and 19.1 months for those treated with ICI therapy alone. In an adjusted analysis, the combination therapy arm had a significant 67% reduction in the risk for all-cause mortality.
The study cohort consisted of 367 patients—232 who underwent CN and received ICI therapy and 135 who received ICI therapy alone. Survivors had a median follow-up of 28.4 months.
Of the patients undergoing CN, 202 (87%) underwent upfront CN, and 30 (13%) deferred the surgery. The investigators found no significant differences in overall survival between patients who had upfront CN and those who deferred CN.
ICI therapy was used as first-line and second-line treatment in 28.1% and 17.4% of patients, respectively, and third-line or subsequent lines of therapy in 54.5% of patients.
The researchers conducted a subgroup analysis of patients who received an ICI as first-line therapy. In this group, the median overall survival was not reached in patients who underwent CN and was 14.9 months in those who received ICI therapy alone. In a multivariable analysis, the addition of CN to ICI therapy was associated with a significant 81% reduction in the risk of death.
“Our data support the continued use of CN in carefully selected patients with mRCC undergoing treatment with contemporary immunotherapy,” the researchers concluded.
They added that these findings “add to the emerging literature regarding optimal management of patients with mRCC in contemporary practice. The speed at which immunotherapy has surpassed targeted treatment has left guidance regarding surgery for mRCC unclear. Timely retrospective analyses offer crucial direction until knowledge gaps can be filled with large prospective clinical trials.”
Gross EE, Li M, Yin M, et al. A multicenter study assessing survival in patients with metastatic renal cell carcinoma receiving immune checkpoint inhibitor therapy with and without cytoreductive nephrectomy. Urol Oncol. Published online October 26, 2022. doi:10.1016/j.urolonc.2022.08.013
This article originally appeared on Renal and Urology News