Efficacy of incomplete metastasectomy in combination with targeted therapy in metastatic kidney cancer patients

Objective. To increase the effectiveness of drug treatment via systemic therapy (ST) in combination with incomplete cytoreductive interventions – incomplete metastasectomy (iME).

Materials and methods. Three centers took part in the study. All 147 patients with mRCC received anticancer drug therapy. Part of them (n = 47) underwent surgery (iME) before or together with anticancer treatment, where iME meant complete metastasis excision within one organ with residual tissue in other organs (research group). Control group (n = 100) included patients who received only systemic antitumor treatment. Primary control point was overall survival (OS), secondary – time to progression.

Results. Median OS in combined treatment group was 32 months, while in control group – 29 months (p = 0.21). When analyzing surgical stage in combined treatment, OS was statistically more significant in patients with iME before ST (n = 20) than in patients with two parallel treatment schemes: 46 and 31 months, respectively (p = 0.007). When analyzing metastases localization, it was found that iME is effective for metastases to distant lymph nodes and adrenal gland. Adrenalectomy (p = 0.03) and lymphadenectomy (p = 0.04) showed higher results than ST: 17 and 15 months versus 6 month, respectively. IME in patients with poor prognosis did not reveal any advantages: median OS reached 7 months, which was significantly inferior to the favorable prognosis group, where median OS was 25 months (p = 0.03).

Conclusion. IME can be used as a part of combined treatment in mRCC patients. It should be considered as the first treatment stage with subsequent ST.

1. Alekseyev B.Ya., Kalpinsky A.S. Sequential use of target agents and their combination in the treatment for metastatic renal cell carcinoma. Onkourologiya = Cancer Urology 2010;(4):16–23. (In Russ.).

2. Ljungberg B., Bensalah K., Bex A. et al. Guidelines on renal cell carcinoma. EAU 2015. 30 p.

3. Psutka S.P., Chang S.L., Cahn D. et al. Reassessing the role of cytoreductive nephrectomy for metastatic renal cell carcinoma in 2019. Am Soc Clin Oncol Educ Book 2019;39:276–83. DOI: 10.1200/EDBK_237453.

4. De Brujin R.E., Mulders P., Jewett M.A. et al. Surgical safety of cytoreductive nephrectomy following sunitinib: results from the multicentre, randomised controlled trial of immediate versus deferred nephrectomy (SURTIME). Eur Urol 2019;76(4):437–40. DOI: 10.1016/j.eururo.2019.06.006.

5. Alt A.L., Boorjian S.A., Lohse C.M. et al. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer 2011;117(13):2873–82. DOI: 10.1002/cncr.25836.

6. Davydov M.I., Matveev V.В., Polotsky В.Е. Surgical treatment of renal carcinoma metastases to the lungs. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Onkology 2003;4:15–8. (In Russ.).

7. You D., Lee C., Jeong I.G. et al. Impact of metastasectomy on prognosis in patients treated with targeted therapy for metastatic renal cell carcinoma. J Cancer Res Clin Oncol 2016;142(11):2331–8. DOI: 10.1007/s00432-016-2217-1.

8. Ljungberg B., Albiges L., Bensalah K. et al. Guidelines on renal cell carcinoma. EAU 2018. Pp. 34–40.