Deferred Cytoreductive Nephrectomy Following Presurgical Vascular Endothelial Growth Factor Receptor-targeted Therapy in Patients with Primary Metastatic Clear Cell Renal Cell Carcinoma: A Pooled Analysis of Prospective Trial Data

de Bruijn, Roderick; Wimalasingham, Akhila; Szabados, Bernadett; Stewart, Grant D.; Welsh, Sarah J.; Kuusk, Teele; Blank, Christian; Haanen, John; Klatte, Tobias; Staehler, Michael; Powles, Thomas und Bex, Axel (2020): Deferred Cytoreductive Nephrectomy Following Presurgical Vascular Endothelial Growth Factor Receptor-targeted Therapy in Patients with Primary Metastatic Clear Cell Renal Cell Carcinoma: A Pooled Analysis of Prospective Trial Data. In: European Urology Oncology, Bd. 3, Nr. 2: S. 168-173

Abstract

Background: Cancer du Rein Metastatique Nephrectomie et Antiangiogeniques (CARMENA) concluded that sunitinib alone is not inferior to cytoreductive nephrectomy (CN) followed by vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) in patients with metastatic renal cell carcinoma. It remains uncertain whether deferred CN is beneficial in this setting. Objective: The aim of this study was to compare outcome in patients treated with presurgical VEGFR-TKI followed by CN (deferred CN) with that in patients receiving CN followed by VEGFR-TKI (upfront CN). Design, setting, and participants: Pooled data from prospective trials in which a strategy of deferred CN in the absence of disease progression was investigated were compared with a retrospective dataset of upfront CN. Outcome measurements and statistical analysis: Overall survival (OS) in the Memorial Sloan-Kettering Cancer Center (MSKCC) intermediate-risk group. Results and limitations: Patients were treated between 2006 and 2016. In the MSKCC intermediate-risk group, 144 patients with a strategy of deferred CN after systemic therapy were compared with 131 patients treated with upfront CN. OS in the deferred cohort was 33.0 mo (95% confidence interval [CI] 25.0-51.0) compared with 22.8 mo (95% CI 17.9-30.6) after upfront CN (hazard ratio 0.72 [95% CI 0.52-0.996], p = 0.047). This study is limited by retrospective comparison of data, subgroup analysis, and a lack of intention-to-treat data for the upfront CN cohort. Conclusions: InMSKCCintermediate-riskpatients,astrategyofdeferredCNintheabsenceofprogressionyieldsOS,whichcomparesfavourablywithupfrontCNandpublishedtrialdatafromCARMENA.This warrantsaformalindividualpatientdataanalysisofCARMENA, SURTIME, andsingle-armprospective studiestodefinetheroleandtimingofdeferredCNinintermediate-riskpatients. Patient summary: In this study, we report outcomes in patients with metastatic renal cell cancer treated with targeted therapy followed by nephrectomy, which compared favourably with nephrectomy followed by targeted therapy and results from published studies. (C) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch