Survival Improves in mRCC With Surgical Metastasectomy

Ana Molina MDThis is an excerpt of an article that appeared in Medscape in which Dr. Ana Molina comments on recent research published in the Journal of Urology. Read the full story here.

In patients with metastatic renal cell carcinoma (mRCC), the surgical removal of metastases — complete metastasectomy (CM) — is associated with significantly longer overall survival compared with incomplete metastasectomy. This conclusion comes from a meta-analysis that included more than 2000 patients and was reported in the January issue of the Journal of Urology.

Patients who did not undergo CM were 2.4 times more likely to die of their disease than were patients with mRCC who underwent CM, report the authors.

Medscape Medical News reached out to medical oncologists who were not associated with the study for their expert insights.

“Although there are limitations to the observational data presented in this article, the work reflects our move away from the conventional thinking that surgery is reserved for localized disease and systemic therapy is for metastatic disease,” Ana Molina, MD, medical oncologist at Weill Cornell Medicine and New York-Presbyterian, New York City, told Medscape Medical News. “The role of surgery in the management of patients with advanced RCC is of great interest and significance,” she added.

The researchers argue that although the National Comprehensive Cancer Network already recommends this approach (and nephrectomy), it may also be appropriate in patients with metastases at multiple organ sites. Indeed, in six of the studies chosen for the meta-analysis, 36% to 56% of patients had metastases to multiple organs. A sensitivity analysis, which excluded patients with single-organ metastases, found a persistent survival benefit for patients who underwent CM.

“In our clinical practice, we are referring patients to undergo metastasectomy when possible. Typically these patients have oligometastatic RCC,” Dr Molina said.

Dr Molina indicated that the role of systemic therapy after metastasectomy is being formally studied in a prospective study. The ECOG-ACRIN (NCT01575548) cooperative group study is enrolling patients with completely resected metastatic clear cell RCC to pazopanib vs placebo for 12 months.

In addition, a randomized study comparing the programmed cell death ligand-1 antibody atezolizumab vs placebo recently opened for patients with high-risk RCC after nephrectomy. This study is also enrolling fully resected patients after metastasectomy (NCT03024996), Dr Molina pointed out.

“Results from these studies will provide much-needed information on the role of systemic therapy and metastasectomy for patients with advanced RCC,” Dr Molina said.

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