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| |  Cytoreductive Nephrectomy Improves Overall Survival With VEGF Agents in Renal Cancer: Presented at ASCO-GU By Fred Gebhart SAN FRANCISCO -- March 9, 2010 -- Cytoreductive nephrectomy can improve overall survival for patients with metastatic renal cell carcinoma who are being treated with anti-vascular endothelial growth factor (VEGF) agents, according to a study presented here at the 2010 Genitourinary Cancers Symposium (ASCO-GU). Researchers analysed data collected on more than 300 patients in the RCC Consortium Database who had undergone both cytoreductive nephrectomy and VEGF therapy. “Patients who underwent cytoreductive nephrectomy had a statistically longer survival,” said Tony Choueiri, MD, Dana-Farber Cancer Institute, Boston, Massachusetts, on March 8. “Even patients with negative prognostic factors did better with cytoreductive nephrectomy. The RCC Consortium Database includes 645 patients from 7 centres across North America, said Dr. Choueiri. All patients were treated with at least 1 anti-VEGF agent, including sunitinib, sorafenib, or bevacizumab. Data were collected via uniform standards and standardised definition for a medial follow up of 28.5 months. The primary endpoint for the analysis was overall survival from time of anti-VEGF drug initiation to death or censored at the last follow-up. A total of 331 patients were eliminated because they had a nephrectomy, but not a cytoreductive nephrectomy, leaving 314 patients for the analysis. In general, patients who received a cytoreductive nephrectomy were somewhat younger and more likely to have had sorafenib, a longer time between diagnosis and treatment, a higher Karnofsky Performance Scale (KPS) score, and more metastases than patients who did not have a cytoreductive nephrectomy. Overall survival for the cytoreductive nephrectomy group was 19.8 months, versus 9.4 months for patients who did not have the procedure. The results produced a hazard ratio (HR) of 0.44 in favour of cytoreductive nephrectomy (P < .001). Favourable results for cytoreductive nephrectomy persisted even for patients who had >=1 negative prognostic factors including a KPS score <80, <12 months between diagnosis and treatment, anaemia, hypercalcaemia, neutrophilia, or thrombocytosis. Multivariate analysis produced an overall HR of 0.68 in favour of cytoreductive nephrectomy (P = .04). Intermediate-risk patients with 1 or 2 risk factors had a HR of 0.46 (P = .004). Poor-risk patients with 3-6 adverse prognostic factors had a HR of 0.67 (P = .056). Dr. Choueiri noted that they found similar results favouring cytoreductive nephrectomy when the analysis was adjusted with the Memorial Sloan-Kettering Cancer Center set of risk factors. “These patients are representative of real patients in the era of VEGF-targeted therapy,” Dr. Choueiri said. “Overall survival is markedly improved compared with similar categories in the immunotherapy era.” He added that cytoreductive nephrectomy improved overall survival even after known prognostic factors were taken into account. The benefit was more marginal in poor-risk patients, who nonetheless still benefitted. Prospective, randomised trials are in the planning stage. The conference is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Therapeutic Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO). [Presentation title: The Impact of Cytoreductive Nephrectomy in Patients With Metastatic Renal Cell Carcinoma (mRCC) Treated With Vascular Endothelial Growth Factor (VEGF)-Targeted Therapy. Abstract 311]
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