Cytoreductive Nephrectomy: Still Necessary in 2021

Méjean, Arnaud; Bex, Axel

doi:10.1016/j.euros.2021.08.015

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…First with the CheckMate 025 trial and subsequently with the CheckMate 214, KEYNOTE-426, CLEAR, IMmotion151, and JAVELIN Renal 101 trials, immunotherapies have become a staple in the management of mRCC. In the metastatic setting, immune checkpoint inhibitor combination therapies have led to primary tumor shrinkage [ 25 ]. With the advent of immune checkpoint inhibitors, the role for cytoreductive surgery remains unknown ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“… Depiction of the different eras of systemic therapy and the landmark papers evaluating the role of CN during these periods [ 10 , 11 , 13 , 14 , 15 , 17 , 18 , 21 , 22 , 25 , 28 ]. …”

Section: Resultsmentioning

confidence: 99%

“…The NORDIC SUN trial is evaluating the role of deferred CN in patients who have at least three IMDC high-risk features and are receiving combination nivolumab and ipilimumab [ 25 ]. The rationale behind the deferred CN is that it still provides the benefit of surgery while not delaying systemic immune checkpoint inhibition.…”

Section: Resultsmentioning

confidence: 99%

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New Paradigms for Cytoreductive Nephrectomy

Lichtbroun

Srivastava

Doppalapudi

et al. 2022

Cancers

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The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over the course of the past few decades. With the advent of immuno-oncologic (IO) agents, there has been a paradigm shift in the treatment of RCC. Within this new era of cancer care, the role of CN is unclear. There are several studies currently underway that aim to assess the role of CN in combination with these therapies. We reviewed articles examining CN, both historically and in the modern immunotherapy era. While immune-oncologic agents are relatively new and large clinical trials have yet to be completed, data thus far is promising that CN may provide clinical benefit. Multiple ongoing trials may clarify the role of CN in this new era of cancer care.

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Section: Resultsmentioning

confidence: 99%

“… Depiction of the different eras of systemic therapy and the landmark papers evaluating the role of CN during these periods [ 10 , 11 , 13 , 14 , 15 , 17 , 18 , 21 , 22 , 25 , 28 ]. …”

Section: Resultsmentioning

confidence: 99%

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New Paradigms for Cytoreductive Nephrectomy

Lichtbroun

Srivastava

Doppalapudi

et al. 2022

Cancers

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“…That study is the only randomized controlled trial investigating the e cacy of nephrectomy in patients with metastatic ccRCC receiving anti-VEGF therapy. A post hoc analysis of CARMENA trial assessing patients with one versus two intermediate risk factors according to the International Metastatic RCC Database Consortium (IMDC) classi cation found that upfront CN could be performed in patients with low-volume mRCC and a single IMDC intermediate risk factor, whereas in the presence of a second risk factor, systemic treatment with the option to perform deferred CN in cases with a response at metastatic sites should be preferred 13 .…”

Section: Introductionmentioning

confidence: 99%

Effects of Cytoreductive Nephrectomy on Nivolumab Outcomes in Patients with Metastatic Clear Cell Renal Carcinoma: A Retrospective Observational Real-Life Data of Turkish Oncology Group

Ocak

Şahin

Ertürk

et al. 2022

Preprint

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Renal cell carcinoma is the fourteenth most common cancer in the world with a male to female ratio of 2:1, and clear cell renal cell carcinoma (ccRCC) is the most common histological subtype. Nivolumab is preferred as subsequent therapy in patients with metastatic ccRCC who show progress after at least one line of anti-vascular endothelial growth factor (anti-VEGF) agents. For several decades, removal of the primary tumor, called cytoreductive nephrectomy, was the cornerstone in the treatment of newly diagnosed metastatic ccRCC. There is limited information about how cytoreductive nephrectomy affects survival outcomes in metastatic ccRCC patients treated with nivolumab. In our study, we aimed to investigate the effect of cytoreductive nephrectomy on nivolumab survival outcomes in metastatic ccRCC patients. Our study included 106 de novo metastatic ccRCC patients with a history of nephrectomy at the time of diagnosis from 20 oncology centers in the Turkish Oncology Group. Multivariate Cox regression analysis was performed to investigate the factors affecting survival in patients receiving nivolumab. The median age of the patients was 60.0 (minimum 18.7-maximum 79.2) years. Eighty-three (78.3%) of the patients had undergone cytoreductive nephrectomy. The median overall survival (OS) of the patients receiving nivolumab was 22.7 months (95% CI 16.1–29.3), and the median time-to-treatment discontinuation (TTD) was 12.0 months (95% CI 8.7–15.3). In the multivariate analysis, cytoreductive nephrectomy (p = 0.011) and the International Metastatic RCC Database Consortium (IMDC) risk score (p = 0.024) were among the significant factors affecting TTD, and the IMDC risk score (p = 0.006) was among the significant factors affecting OS. Our study showed that TTD of nivolumab was longer in metastatic ccRCC patients treated with cytoreductive nephrectomy and progressed after at least one line of anti-VEGF agents.

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