Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy: Scientifically Relevant or Natural Selection?

Biswas, Bivas; Dabkara, Deepak; Ganguly, Sandip; Eswaran, Prasad; Ghosh, Joydeep

doi:10.1200/jco.2016.70.8156

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…The decreased tumor burden that occurred with the disappearance of the primary tumor lesion provided better prognostic outcomes with systemic TT. However, good performance status and a primary tumor accounting for >75% of the overall tumor burden without any metastatic lesions in the central nervous system and liver did not yield a better prognostic outcome for every mRCC patient after cytoreductive nephrectomy, which resulted in a low rate of nephrectomy in the targeted era [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective comparative study of progression-free survival and overall survival between metachronous and synchronous metastatic renal cell carcinoma in intermediate- or poor-risk patients treated with VEGF-targeted therapy

et al. 2017

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IntroductionThe aim of this study was to compare progression-free survival (PFS) and overall survival (OS) between metachronous and synchronous metastatic renal cell carcinomas treated with VEGF-targeted therapy.MethodsBetween 2005 and 2014, 93 (78.8%) intermediate- and 25 (21.2%) poor-Heng-risk patients, including 32 (27.1%) patients with metachronous and 86 (72.9%) patients with synchronous renal cell carcinoma, were enrolled retrospectively. PFS and OS values were compared according to the number of risk factors and treatment-free interval using the Kaplan-Meier method and log-rank test. The prognostic risk factors were also evaluated using a Cox proportional hazard model, with a p-value < 0.05 indicating statistical significance.ResultsDuring a median 5.0-month treatment and 59.3-month follow-up, analysis of the PFS/OS of SM (5.2/9.6 months) and MM (9.6/20.1 months) yielded a significant difference in OS (p = 0.010). However, there was no significant difference when Heng risk groups and treatment-free interval were considered (p > 0.05). There was a significant difference in PFS (hazard ratio: 1.81) and OS (hazard ratio: 2.19) with increasing number of Heng risk factors among patients with synchronous renal cell carcinoma and a treatment-free interval <1 year. Metastatic type, anemia, and neutrophilia were significant predictive factors for OS in multivariable analysis (p < 0.05).ConclusionThe metastatic type of renal cell carcinoma (synchronous or metachronous) significantly affects survival; metachronous type is associated with more favorable outcomes than synchronous type. However, after stratification according to Heng risk factors and treatment-free interval, the differences in survival between metachronous and synchronous type were insignificant.

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Section: Discussionmentioning

confidence: 99%

A retrospective comparative study of progression-free survival and overall survival between metachronous and synchronous metastatic renal cell carcinoma in intermediate- or poor-risk patients treated with VEGF-targeted therapy

et al. 2017

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“…Utilized in patients with de novo metastatic RCC or patients with metastatic progression following primary surgical management, they have been demonstrated to extend progression-free survival by 3-8 months in patients with clear-cell histology [1,2,6,7]. Their introduction has even called into question the oncologic value of cytoreductive nephrectomy, which was first established in the cytokine era [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

Chandrasekar

Klaassen

Goldberg

et al. 2018

European Urology Supplements

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Objective: To utilize a population-based approach to address the role of adjuvant TT in the management of RCC.Methods: Patients with RCC (2006-2013) in the SEER database were stratified by metastatic disease at the time of diagnosis (cM0/cM1). cM0 patients following surgical excision were stratified into low and high-risk (ASSURE and S-TRAC criteria). Multivariable analyses performed to identify predictors of TT receipt; Fine and Gray competing risks analyses used to identify predictors of cancer-specific mortality (CSM). Subset analyses included patients with clear cell histology and high-risk cM0. Survival analyses were used to evaluate overall survival (OS) and cancer-specific survival (CSS) for all cohorts, stratified on TT receipt.Results: 79,926 patients included (71,682 cM0, 8,244 cM1); median follow-up for the entire cohort was 40.1 months. Of 31,453 patients with histologic grade data, 18,328 and 13,125 were low-and high-risk cM0, respectively. TT utilization in cM1 patients peaked at 50.6% and was associated with reduced CSM (HR 0.73, p<0.01). In contrast, TT utilization (presumed salvage therapy) never exceeded 2.2% in the entire cM0 cohort and 3.5% in the high-risk cM0 cohort. On competing risks analysis, TT receipt was associated with increased CSM in all cohorts.Conclusion: When compared to the cM1 patients, TT receipt in cM0 patients does not provide any cancer-specific survival benefit, even in the small percentage of patients that eventually progress to metastatic disease. Competing risks mortality further limit any potential benefit in this population. Based on current evidence, adjuvant TT cannot be recommended for RCC patients.

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The role of pazopanib on tumour angiogenesis and in the management of cancers: A review

Chellappan

Chellian

et al. 2017

Biomedicine & Pharmacotherapy

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Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy: Scientifically Relevant or Natural Selection?

Cited by 6 publications

References 8 publications

A retrospective comparative study of progression-free survival and overall survival between metachronous and synchronous metastatic renal cell carcinoma in intermediate- or poor-risk patients treated with VEGF-targeted therapy

A retrospective comparative study of progression-free survival and overall survival between metachronous and synchronous metastatic renal cell carcinoma in intermediate- or poor-risk patients treated with VEGF-targeted therapy

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

The role of pazopanib on tumour angiogenesis and in the management of cancers: A review

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