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Cytoreductive nephrectomy in metastatic renal cell carcinoma: outcome of patients treated with a multidisciplinary, algorithm-driven approach

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Abstract

Purpose

Metastatic renal cell carcinoma (mRCC) represents a significant and rising burden of disease, with rapidly evolving treatment modalities. The role of cytoreductive nephrectomy (CN) is controversial in this setting. As such, London Cancer has pursued a multidisciplinary team (MDT) approach when assessing suitability for surgery.

Methods

A retrospective analysis of treatment-naive synchronous mRCC patients, managed via a renal-specialist MDT, was conducted between January 2015 and December 2018. An MDT selection algorithm for CN—using the International Metastatic Renal Cell Carcinoma Database Consortium score (IMDC), performance status and metastatic disease burden—was developed.

Results

87 treatment-naive synchronous mRCC patients received either CN (n = 18), Systemic therapy (ST) alone (n = 43) or Best supportive care (BSC) (n = 26). Progression free survival (PFS) and overall survival (OS) were assessed. 51% and 39% were IMDC intermediate and poor risk. Median PFS was 28.6 months and 4.5 months in the CN group and ST alone group, respectively, Hazard Ratio for death was 3.63 [(95% CI 1.68–7.83) p < 0.05]. OS remains immature for the CN group, but a median OS of 12.8 months was observed in the ST group and 5.0 months for BSC. 1-year OS rate for CN, ST and BSC groups was 77.8%, 55.8% and 23.10%, respectively.

Conclusion

These findings describe outcomes of an unselected series of patients treated via an MDT-driven, protocolised treatment pathway. MDT pathway-based decision making may improve patient selection for CN. Further research is needed to evaluate the role of CN amongst a growing landscape of treatment strategies, including immune checkpoint inhibitors and combination therapies.

Patient summary

Multi-disciplinary team, pathway-based treatment strategy may improve patient selection for cytoreductive nephrectomy in patients with metastatic renal cell carcinoma.

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References

  1. Public Health England. National Cancer Registration and Analysis Service (NCRAS) (2016) London: NCIN. https://www.ncin.org.uk/publications/survival_by_stage. Published 2016.

  2. Scotland I. Detect Cancer Early Staging Data (2016) Scotland: ISD. https://www.isdscotland.org/Health-Topics/Cancer/Detect-Cancer-Early/. Published 2016.

  3. Belfast QU (2010). Incidence by stage 2010–2014. Northern Ireland Cancer Registry. https://www.qub.ac.uk/research-centres/nicr/CancerInformation/official-statistics/.

  4. Flanigan RC, Salmon SE, Blumenstein BA et al (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345(23):1655–1659. https://doi.org/10.1056/NEJMoa003013

    Article  CAS  PubMed  Google Scholar 

  5. Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R (2001) Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet (Lond Engl) 358(9286):966–970. https://doi.org/10.1016/s0140-6736(01)06103-7

    Article  CAS  Google Scholar 

  6. Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171(3):1071–1076. https://doi.org/10.1097/01.ju.0000110610.61545.ae

    Article  PubMed  Google Scholar 

  7. Motzer RJ, Tannir NM, McDermott DF et al (2018) Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med 378(14):1277–1290. https://doi.org/10.1056/NEJMoa1712126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mejean A, Ravaud A, Thezenas S et al (2018) Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 379(5):417–427. https://doi.org/10.1056/NEJMoa1803675

    Article  CAS  PubMed  Google Scholar 

  9. Bex A, Mulders P, Jewett M et al (December 2018) Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: The SURTIME Randomized Clinical Trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2018.5543

    Article  PubMed Central  Google Scholar 

  10. Bhindi B, Abel EJ, Albiges L et al (2019) Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol 75(1):111–128. https://doi.org/10.1016/j.eururo.2018.09.016

    Article  PubMed  Google Scholar 

  11. Mejean A, Thezenas S, Chevreau C, Bensalah K, Geoffrois L, Thiery-Vuillemin A, Cormier L, Lang H, Guy L, Gravis G, Rolland F, Linassier C, Timsit M-O, Albiges L, Stephane Oud AR (2019) Cytoreductive nephrectomy (CN) in metastatic renal cancer (mRCC): update on carmena trial with focus on intermediate IMDC-risk population. J Clin Oncol. 37(15_supplement):4508–4508. https://doi.org/10.1200/JCO.2019.37.15_suppl.4508

  12. Powles T, Kelly J (2013) Innovation: london cancer-multidisciplinary approach to urological cancer. Nat Rev Clin Oncol 10(11):609–610. https://doi.org/10.1038/nrclinonc.2013.179

    Article  PubMed  Google Scholar 

  13. Neves JB, Shepherd S, Cullen D, Powles T, Aitchison M, Tran MG (2019) Performance and cost of a renal cancer specialist multidisciplinary team meeting: Results from 1500 discussions. J Clin Urol 12(4):314–319. https://doi.org/10.1177/2051415819829309

  14. Royal Free Hospital Nephrectomy Outcomes Data (2019) The British association of urological surgeons. https://www.baus.org.uk/patients/surgical_outcomes/nephrectomy/hospital.aspx?id=144. Published 2019.

  15. Dingemans A-MC, Hendriks LEL, Berghmans T, et al (2019) Definition of synchronous oligometastatic non-small cell lung cancer-a consensus report. J Thorac Oncol 14(12):2109–2119. https://doi.org/10.1016/j.jtho.2019.07.025

  16. Online Resource 1: details of systemic treatment received in the systemic therapy alone and cytoreductive nephrectomy cohorts

  17. Vallejo-Torres L, Melnychuk M, Vindrola-Padros C et al (2018) Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. Br J Surg 105(5):587–596. https://doi.org/10.1002/bjs.10761

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Noe A, de Bruijn RE, Blank C, Horenblas S, Haanen J, Bex A (2016) Comparison of pre-treatment MSKCC and IMDC prognostic risk models in patients with synchronous metastatic renal cell carcinoma treated in the era of targeted therapy. World J Urol 34(8):1067–1072. https://doi.org/10.1007/s00345-016-1769-7

    Article  CAS  PubMed  Google Scholar 

  19. Heng DYC, Wells JC, Rini BI et al (2014) Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 66(4):704–710. https://doi.org/10.1016/j.eururo.2014.05.034

    Article  PubMed  Google Scholar 

  20. Heng DYC, Xie W, Regan MM et al (2013) External validation and comparison with other models of the international metastatic renal-cell carcinoma database consortium prognostic model: a population-based study. Lancet Oncol 14(2):141–148. https://doi.org/10.1016/S1470-2045(12)70559-4

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bex A, de Bruijn R, Noe A, Blank CU (2016) Simon Horenblas JBAGH. Time to targeted therapy after cytoreductive nephrectomy (CN) and surveillance in patients with synchronous unresectable metastases of renal cell carcinoma (RCC). J Clin Oncol. 34:604.

  22. de Bruijn RE, Kuusk T, Noe AP et al (2017) Observation after cytoreductive nephrectomy in patients with synchronous not completely resected metastases of renal cell carcinoma. Urology 109:127–133. https://doi.org/10.1016/j.urology.2017.06.048

    Article  PubMed  Google Scholar 

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Author notes

  1. Wing K. Liu and J. M. Lam Joint first authors.

Authors and Affiliations

  1. Barts and The London School of Medicine and Dentistry, Barts Cancer Institute, Queen Mary University of London, London, UK

    Wing K. Liu, J. M. Lam, T. Butters, M. Grant, F. Jackson-Spence, T. Powles & B. Szabados

  2. UCL Division of Surgery and Interventional Science, Renal Cancer Unit, Royal Free Hospital, London, UK

    Wing K. Liu, M. Grant, A. Bex & T. Powles

  3. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    A. Bex

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  1. Wing K. Liu
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Correspondence to T. Powles.

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Conflict of interest

Professor Thomas Powles, Research funding for A&Z, Roche and Exelixis Pharmaceuticals. Honorarium for speeches for BMS, Novartis, Merck, Pfizer, MSD, Ipsen and Bristol-Myers Squibb Pharmaceuticals. Axel Bex, research funding from Pfizer, honorarium for ad boards with Pfizer, BMS, Novartis, Ipsen, Roche/Genentech.

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Liu, W.K., Lam, J.M., Butters, T. et al. Cytoreductive nephrectomy in metastatic renal cell carcinoma: outcome of patients treated with a multidisciplinary, algorithm-driven approach. World J Urol 38, 3199–3205 (2020). https://doi.org/10.1007/s00345-020-03107-0

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  • DOI: https://doi.org/10.1007/s00345-020-03107-0

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