Nephrectomy for Metastatic Renal Cancer in the Age of Targeted Therapy

Summary and Comment |
July 8, 2016

Nephrectomy for Metastatic Renal Cancer in the Age of Targeted Therapy

  1. Robert Dreicer, MD, MS, FACP, FASCO

Adding cytoreductive nephrectomy to targeted therapy significantly improved overall survival.

  1. Robert Dreicer, MD, MS, FACP, FASCO

Prior to the promulgation of data from phase III trials demonstrating an improvement in survival in patients with metastatic renal cancer treated with interferon who underwent cytoreductive nephrectomy, the role of nephrectomy in the metastatic setting was believed to be purely palliative (to reduce pain or stop bleeding). Although we are now more than 10 years into the targeted-therapy era in renal cancer, there remains a paucity of data to inform practice regarding the role of cytoreductive nephrectomy.

Using the National Cancer Data Base, investigators have now conducted a retrospective analysis to assess the frequency and utility of cytoreductive nephrectomy in more than 15,000 patients with metastatic renal cancer who received a targeted agent between 2006 and 2013. In this cohort, 35% of patients underwent cytoreductive nephrectomy, the utilization rate of which remained stable during the study period. Characteristics that led to high utilization of nephrectomy included younger age, lower tumor stage, private insurance, and treatment at an academic medical center.

The median time to death was longer for patients undergoing nephrectomy versus no surgery (17.1 vs 7.7 months; P<0.001). In multivariable Cox regression analyses, patients undergoing nephrectomy had a lower risk for any death (hazard ratio, 0.49; P< 0.001).

Comment

As noted by the authors, this experience must be interpreted with caution because it is retrospective and has the limitations of the database, which lacks information on preoperative lab values and is incomplete regarding the type of targeted agent used. An ongoing trial is evaluating the role of cytoreductive nephrectomy. But until such data are available, cytoreductive nephrectomy remains a viable management strategy in carefully selected patients — i.e., with good performance status, lack of rapidly progressive disease, and the bulk of tumor within the renal primary (selection criteria from the original phase III trials).

Editor Disclosures at Time of Publication

  • Disclosures for Robert Dreicer, MD, MS, FACP, FASCO at time of publication Consultant / Advisory board Medivation; Genentech/Roche; Ferring; Asana; Churchill Pharma; Tokai Editorial boards Urology; Clinical Genitourinary Cancer; Current Urology Reports Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee); Bladder Cancer Advocacy Network (Member, Scientific Advisory Board)

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