Cytoreductive nephrectomy for small RCC tumors questioned
medwireNews: Researchers have found that cytoreductive radiofrequency ablation (cRFA) plus sunitinib offers limited benefits over sunitinib alone in the treatment of small tumors in patients with metastatic renal cell carcinoma (RCC).
Their study showed that progression-free survival was longer if cRFA was followed by sunitinib rather than interferon (IFN)-α treatment, at a median of 13.4 months versus 9.1 months. But this improvement in survival was not significantly better than that achieved with sunitinib treatment alone, at 12.7 months.
The findings come from three parallel studies involving a total of 114 RCC patients that assessed the effects of: cRFA followed by IFN-α treatment three times a week; cRFA followed by 4 weeks of sunitinib 50 mg/day treatment and 2 weeks off treatment; and sunitinib alone.
Treatment with sunitinib alone resulted in better objective response rates than sunitinib plus cRFA, albeit not significantly (32% and 29%, respectively), and both rates were significantly better than that achieved with cRFA plus IFN-α (8%).
However, despite progression-free survival being similar with sunitinib and sunitinib plus cRFA , overall survival was a significant 4.7 months longer with sunitinib plus cRFA treatment.
The team, led by Ilya Tsimafeyeu (Kidney Cancer Research Bureau, Moscow, Russia), says that this may reflect a true treatment advantage, but it “needs to be tested in a larger study.”
The emergence of targeted therapy “has prompted a re-evaluation of the benefit and optimum timing of cytoreductive surgery,” the researchers note in BJU International.
While “large-scale retrospective studies have confirmed the benefit of cytoreductive nephrectomy before targeted therapy, which is the dominant treatment paradigm… initial nephrectomy may be deferred in some patients,” they comment.
They also point out that disease progression during recovery from surgery is a possible risk associated with upfront cRFA and may preclude patients from receiving subsequent systemic therapy.
The current findings show that “sunitinib was effective in patients with metastatic RCC with an unresected small primary tumor,” say the researchers, and “there were no unexpected toxicities of medical treatment.”
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By Lucy Piper, Senior medwireNews Reporter