Cytoreductive nephrectomy may improve survival rates of those treated with ICI for metastatic renal cell carcinoma

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Those already receiving treatment for metastatic renal cell carcinoma (mRCC) with immune checkpoint inhibitor (ICI) therapy can benefit from cytoreductive nephrectomy (CN) procedures, which increase overall survival (OS) rates. That is according to a recent Urologic Oncology-published investigation led by Sarah P Psutka (University of Washington, Seattle, USA).

The research examined whether mRCC patients experienced improved rates of survival with ICI combined with CN, rather than with ICI alone. To do so, the researchers carried out a multicentre retrospective study comprising the data of 367 patients, with a median survivor follow-up of 28.4 months. ICI therapy was used by all the patients studied, though in 28.1% as first-line treatment, 17.4% as second-line and 54.5% as third- or subsequent line. OS was measured using Kaplan Meier analyses.

The group of patients who underwent CN in addition to their ICI therapy demonstrated a longer median OS compared to the ICI-only group, with an OS of 56.3 months (IQR 50.2–79.8) compared to 19.1 months (IQR 12.8–23.8). All-cause mortality of those in the CN group was 67% lower than in the ICI-only group. Notably, the reduction in mortality applied regardless of whether ICI was used as a first-, second-, or third-line therapy.

To explain the findings, the study authors pointed to theories suggesting that CN “optimises the immune environment.” They also noted that “surgery can reduce local symptoms,” allowing ICI to be more effective. Other cytoreductive surgeries have been used effectively in the treatment of other cancers.

The authors argued that their data “support consideration of CN in well selected patients with mRCC undergoing treatment with ICI.” With that said, they noted a set of limitations to their study. These included the retrospective nature of the research and the relatively small size of the patient cohort. Nonetheless, they defended retrospective investigations as offering “crucial direction” before full-scale, dedicated clinical trials can be launched. Going forward, they said, there is a need to “evaluate how CN should be sequenced into this new immunotherapy landscape” and to consider “how to best select patients for surgery to optimise survival.”

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