A research team evaluated the efficacy of combining primary immunotherapy (IO) with nephrectomy for the treatment of advanced renal cell carcinoma (RCC).
Patients with advanced or metastatic RCC who received IO followed by nephrectomy were analyzed in the multicenter, retrospective study. The primary outcome was negative surgical margins and no 30-day surgical complications (bifecta), while secondary outcomes included progression-free survival (PFS) after surgery, reduction in tumor/thrombus size, RENAL score, and clinical/pathologic downstaging.
A total of 56 patients were analyzed. Median age was 63 years and median follow-up was 22.5 months; 40 (71.4%) patients were at intermediate risk according to the International mRCC Database Consortium. Patients were treated with immunotherapy for a median duration of 8.1 months, which resulted in reductions in tumor size (P<.001), thrombus size (P=.02), and RENAL score (P<.001).
Clinical downstaging at time of imaging occurred in 38 (67.9%) patients, while 25 (44.6%) patients were pathologically downstaged after surgery (P<.001). Bifecta was achieved in 38 (67.9%) patients; predictors for bifecta achievement included decreasing tumor size (hazard ratio [HR], 1.08; P=.043) and pathologic downstaging (HR, 2.13; P=.047).
Improved PFS was associated with bifecta (HR, 5.65; P=.009), pathologic downstaging (HR, 5.15; P=.02), and increasing reduction in tumor size (HR, 1.2; P=.007). Patients who achieved bifecta demonstrated an improved 2-year PFS (84% vs 71%; P=.019).
Patients who received primary immunotherapy experienced reduced tumor/thrombus size and complexity. Patients who were pathologically downstaged had an improved 2-year PFS and were more likely to achieve bifecta. This study supports further research into nephrectomy use after primary immunotherapy in patients with advanced RCC.