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Kumada N, Iinuma K, Kubota Y, Takagi K, Nakano M, Ishida T, Yokoi S, Sugino F, Kawase M, Takeuchi S, Kawase K, Kato D, Takai M, Tobisawa Y, Ito T, Nakane K, Koie T. Impact of Cytoreductive Nephrectomy in the Management of Metastatic Renal Cell Carcinoma: A Multicenter Retrospective Study. Diseases 2024; 12:122. [PMID: 38920554 PMCID: PMC11202703 DOI: 10.3390/diseases12060122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/04/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
In this study, we aimed to determine the utility of cytoreductive nephrectomy (CN) in real-world clinical practice and investigate whether CN contributes to improved oncological outcomes in patients with metastatic renal cell carcinoma (mRCC). This retrospective multicenter cohort study enrolled patients with mRCC who received systemic therapy at six institutions between May 2005 and May 2023. The patients were divided into those who did not undergo CN (Group I) and those who underwent CN (Group II). The primary endpoints were oncological outcomes, including cancer-specific survival (CSS) and progression-free survival (PFS). Altogether, 137 patients with mRCC were included in this study. The median CSS was 14 months in Group I and 32 months in Group II (p < 0.001). Additionally, the median PFS in Groups I and II was 5 and 13 months, respectively (p = 0.006). A multivariate analysis showed that CN was an independent prognostic factor for CSS and PFS. Hence, CN is a potential treatment modality that can improve oncological outcomes in patients with mRCC.
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Affiliation(s)
- Naotaka Kumada
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
- Department of Urology, Matsunami General Hospital, 185-1 Kasamatsucho, Hashima-gun, Gifu 501-6062, Japan
| | - Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Yasuaki Kubota
- Department of Urology, Toyota Memorial Hospital, 1-1 Heiwacho, Toyota 471-8513, Japan;
| | - Kimiaki Takagi
- Department of Urology, Daiyukai Hospital, 1-9-9 Sakura, Ichinomiya 491-8551, Japan;
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu 500-8717, Japan;
| | - Takashi Ishida
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashimacho, Gifu 500-8513, Japan;
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, Minokamo 505-8510, Japan;
| | - Fumiya Sugino
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Makoto Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Shinichi Takeuchi
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Kota Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Daiki Kato
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Manabu Takai
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Yuki Tobisawa
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan;
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
| | - Takuya Koie
- Department of Urology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan or (N.K.); (F.S.); (M.K.); (S.T.); (K.K.); (D.K.); (M.T.); (Y.T.); (K.N.); (T.K.)
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Song SH, Lee S. Cytoreductive nephrectomy in the age of immunotherapy-based combination treatment. Investig Clin Urol 2023; 64:425-434. [PMID: 37668198 PMCID: PMC10482658 DOI: 10.4111/icu.20230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 09/06/2023] Open
Abstract
Renal cell carcinoma (RCC) displays a wide spectrum of oncological prognosis and clinical behavior, and is noted for its generally poor outcome in metastatic settings. However, the introduction of immunotherapy after the cytokine era has changed the landscape of treatment for metastatic RCC, outperforming previous targeted therapy and providing new hope for patients with advanced disease. Cytoreductive nephrectomy (CN) has been the center of controversy, with questionable survival benefit when compared to systemic therapy. Despite discouraging results from the two randomized clinical trials (CARMENA & SURTIME), interest into the role of CN is being rekindled, and contemporary real-world studies provide supporting evidence to suggest that CN may still have a role in well-selected patients treated or expecting treatment with immunotherapy, not only for symptomatic control but also for oncological benefit. In this review article, we attempt to review the modern insight into the role of CN for metastatic RCC in contemporary medicine, with a focus on treatment with immune checkpoint inhibitor combination-based immunotherapy.
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Affiliation(s)
- Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Dason S, Lacuna K, Hannan R, Singer EA, Runcie K. State of the Art: Multidisciplinary Management of Oligometastatic Renal Cell Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e390038. [PMID: 37253211 DOI: 10.1200/edbk_390038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Oligometastatic renal cell carcinoma (OM-RCC) refers to patients who have limited (typically up to 5) metastatic lesions. Although management principles may overlap, OM-RCC is distinguishable from oligoprogressive RCC, which describes progression of disease to a limited number of sites while receiving systemic therapy. Cytoreductive nephrectomy and metastasectomy are common surgical considerations in OM-RCC, and indications are discussed in this review. It is evident that stereotactic ablative radiotherapy is effective in RCC and is being applied increasingly in the oligometastatic setting. Finally, we will review advances in systemic therapy and the role of active surveillance before the initiation of systemic therapy.
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Affiliation(s)
- Shawn Dason
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Kristine Lacuna
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eric A. Singer
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Karie Runcie
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY
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Goodstein T, Yang Y, Runcie K, Srinivasan R, Singer EA. Two is company, is three a crowd? Triplet therapy, novel molecular targets, and updates on the management of advanced renal cell carcinoma. Curr Opin Oncol 2023; 35:206-217. [PMID: 37226958 PMCID: PMC10213993 DOI: 10.1097/cco.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the most recent changes in the management of advanced renal cell carcinoma, a complicated and ever-changing field of research. RECENT FINDINGS A recent meta-analysis examining combination therapy favors nivolumab plus cabozantinib as the overall survival leader in doublet therapy. Initial results on the first ever trial of triplet therapy have demonstrated improved progression-free survival over current standard of care. The hypoxia-inducible factor-2α (HIF-2α) inhibitor belzutifan is FDA approved for patients with von Hippel-Lindau disease and is currently being investigated in patients with nonhereditary renal cell carcinoma. The new glutamate synthesis inhibitor, telaglenastat, perhaps confers synergistic benefit when combined with everolimus, but combination with cabozantinib was not so effective. Dual mammalian target of rapamycin (mTOR) inhibition with sapanisertib does not appear to be an effective therapeutic option. New biomarkers and targets are actively being investigated. Four recent trials examining alternative agents to pembrolizumab in the adjuvant setting did not demonstrate an improvement in recurrence-free survival. Cytoreductive nephrectomy in the combination therapy era is supported by retrospective data; clinical trials are recruiting patients. SUMMARY The last year ushered in novel approaches of varying success for managing advanced renal cell carcinoma, including triplet therapy, HIF-2α inhibitors, metabolic pathway inhibitors, and dual mTOR inhibitors. Pembrolizumab remains the only modern therapy available in the adjuvant setting, and the waters surrounding cytoreductive nephrectomy are still murky.
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Affiliation(s)
- Taylor Goodstein
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus OH 43206
| | - Yuanquan Yang
- Divsion of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus OH 43206
| | - Karie Runcie
- Division of Medical Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Ramaprasad Srinivasan
- Molecular Therapeutics Section, Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Eric A. Singer
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus OH 43206
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Singer EA, Rumble RB, Van Veldhuizen PJ. Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline Q&A. JCO Oncol Pract 2023; 19:127-131. [PMID: 36595734 DOI: 10.1200/op.22.00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Beirat AF, Menakuru SR, Khan I, Siddiqui S. Pathological Complete Response of Metastatic Clear Cell Renal Carcinoma with Pembrolizumab and Axitinib: A Case Report and Review of Literature. Case Rep Oncol 2023; 16:30-35. [PMID: 36743880 PMCID: PMC9896169 DOI: 10.1159/000529124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
The role of cytoreductive nephrectomy has become unclear since the introduction of immunotherapy which is now the backbone of the treatment for metastatic renal cell carcinoma. Different combinations are used based on the prognosis. Achieving a complete response would be ideal and includes radiographic disappearance of lesions. However, there have been a few reported cases of pathological complete response with persistent radiographic evidence of cancer. The authors report a case of pathological complete response despite persistent radiographic evidence of residual disease in a patient with metastatic renal cell carcinoma treated with pembrolizumab and axitinib. The patient subsequently underwent cytoreductive nephrectomy after the 13th dose of pembrolizumab. The resected mass consisted of scar tissue with no viable tumor cells seen on pathology but only scar tissue. This case reveals that persistent radiographic evidence of the tumor may be explained by scar tissue, challenging the role of cytoreductive nephrectomy in the era of immunotherapy.
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Affiliation(s)
- Amir F. Beirat
- Internal Medicine, Indiana University School of Medicine, Ball Memorial Hospital, Muncie, IN, USA
| | - Sasmith R. Menakuru
- Internal Medicine, Indiana University School of Medicine, Ball Memorial Hospital, Muncie, IN, USA
| | - Ibrahim Khan
- Internal Medicine, Indiana University School of Medicine, Ball Memorial Hospital, Muncie, IN, USA
| | - Salahuddin Siddiqui
- Hematology-Oncology, Indiana University School of Medicine, Ball Memorial Hospital, Muncie, IN, USA
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Mikhail M, Chua KJ, Khizir L, Tabakin A, Singer EA. Role of metastasectomy in the management of renal cell carcinoma. Front Surg 2022; 9:943604. [PMID: 35965871 PMCID: PMC9372304 DOI: 10.3389/fsurg.2022.943604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment of metastatic renal cell carcinoma (mRCC) has evolved with the development of a variety of systemic agents; however, these therapies alone rarely lead to a complete response. Complete consolidative surgery with surgical metastasectomy has been associated with improved survival outcomes in well-selected patients in previous reports. No randomized control trial exists to determine the effectiveness of metastasectomy. Therefore, reviewing observational studies is important to best determine which patients are most appropriate for metastasectomy for mRCC and if such treatment continues to be effective with the development of new systemic therapies such as immunotherapy. In this narrative review, we discuss the indications for metastasectomies, outcomes, factors associated with improved survival, and special considerations such as location of metastasis, number of metastases, synchronous metastases, and use of systemic therapy. Additionally, alternative treatment options and trials involving metastasectomy will be reviewed.
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