Metastatic Kidney Cancer: Difference between revisions
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==== Cytokine Therapy (IFN-'''α)''' ==== | ==== Cytokine Therapy (IFN-'''α)''' ==== | ||
* | *Meta-analysis of 2 trials (SWOG 8949 and EORTC 30947) found significantly improved OS by 5.8 months in CN followed by IFN- α group (13.6 months CN IFN α2b vs. 7.8 months IFN α2b, p=0.02) vs. IFN- α alone | ||
===== <span style="color:#ff00ff">SWOG 8949 ===== | ===== <span style="color:#ff00ff">SWOG 8949 ===== | ||
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*'''The introduction of effective targeted therapy questioned the role of CN in the modern era''' | *'''The introduction of effective targeted therapy questioned the role of CN in the modern era''' | ||
===== | ===== CN followed by Targeted Therapy vs. Targeted Therapy alone ===== | ||
====== | ====== <span style="color:#ff00ff">CARMENA</span> (Clinical Trial to Assess the Importance of Nephrectomy) ====== | ||
* '''Population: 452 patients with metastatic ccRCC''' | * '''Population: 452 patients with metastatic ccRCC''' | ||
** 44% had poor-risk disease, 56% had intermediate-risk | ** 44% had poor-risk disease, 56% had intermediate-risk | ||
*** '''Trial does not apply to patients with favourable-risk''' | *** '''Trial does not apply to patients with favourable-risk''' | ||
* '''Randomized to CN followed by sunitnib vs. sunitnib alone''' | * '''<span style="color:#ff0000">Randomized to CN followed by sunitnib vs. sunitnib alone''' | ||
* '''Primary outcome: OS''' | * '''Primary outcome: OS''' | ||
* '''Median follow-up 50.2 months''' | * '''Median follow-up 50.2 months''' | ||
* '''Results''' | * '''<span style="color:#ff0000">Results''' | ||
** '''OS: sunitinib alone was non-inferior to CN followed by sunitinib''' (HR 0.89; 95% CI 0.71–1.10) | ** '''<span style="color:#ff0000">OS: sunitinib alone was non-inferior to CN followed by sunitinib</span>''' (HR 0.89; 95% CI 0.71–1.10) | ||
** '''No significant difference PFS or response to treatment''' | ** '''No significant difference PFS or response to treatment''' | ||
* Méjean, Arnaud, et al. "Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma." New England Journal of Medicine 379.5 (2018): 417-427. | * [https://pubmed.ncbi.nlm.nih.gov/29860937/ Méjean, Arnaud, et al. "Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma." New England Journal of Medicine 379.5 (2018): 417-427.] | ||
===== CN before vs. after Targeted Therapy ===== | ===== CN before vs. after Targeted Therapy ===== | ||
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====== <span style="color:#ff00ff">SURTIME ====== | ====== <span style="color:#ff00ff">SURTIME ====== | ||
* '''Population: 99 patients with metastatic ccRCC''' | * '''Population: 99 patients with metastatic ccRCC''' | ||
* '''Randomized to upfront CN followed by sunitnib vs. upfront sunitinib followed by CN (deferred CN)''' | * '''<span style="color:#ff0000">Randomized to upfront CN followed by sunitnib vs. upfront sunitinib followed by CN (deferred CN)''' | ||
** '''Investigated optimal timing of CN relative to initiation of systemic therapy''' | ** '''Investigated optimal timing of CN relative to initiation of systemic therapy''' | ||
* '''Primary endpoint: disease progression at 28 weeks''' | * '''Primary endpoint: disease progression at 28 weeks''' | ||
* '''Results:''' | * '''<span style="color:#ff0000">Results:''' | ||
** '''No difference in disease progression''' (42.0% vs. 42.9%, respectively at 28 weeks of follow-up; p>0.99) '''between upfront vs. deferred CN''' | ** '''<span style="color:#ff0000">No difference in disease progression</span>''' (42.0% vs. 42.9%, respectively at 28 weeks of follow-up; p>0.99) '''between upfront vs. deferred CN''' | ||
** '''OS improved in deferred CN group (median OS 32.4 vs. 15 months; p=0.034)''' | ** '''OS improved in deferred CN group (median OS 32.4 vs. 15 months; p=0.034)''' | ||
*** '''Difficult to interpret this result due to discordance with the disease progression results''' | *** '''Difficult to interpret this result due to discordance with the disease progression results''' | ||
* Bex, Axel, et al. "Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial." JAMA oncology 5.2 (2019): 164-170. | * [https://pubmed.ncbi.nlm.nih.gov/30543350/ Bex, Axel, et al. "Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial." JAMA oncology 5.2 (2019): 164-170.] | ||
==== Guideline Recommendations ==== | ==== Guideline Recommendations ==== | ||