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. 2024 Sep 4;31(9):5195-5205.
doi: 10.3390/curroncol31090384.

Can Cytoreductive Nephrectomy Improve Outcomes of Nivolumab Treatment in Patients with Metastatic Clear-Cell Renal Carcinoma?

Birol Ocak  1 , Ahmet Bilgehan Sahin  2 , Ismail Ertürk  3 , Mustafa Korkmaz  4 , Dilek Erdem  5 , Umut Cakıroglu  6 , Mustafa Karaca  7 , Ahmet Dirican  8 , Omer Fatih Olmez  9 , Sabin Goktas Aydın  9 , Ali Gökyer  10 , Ahmet Kücükarda  10 , Ahmet Gülmez  11 , Perran Fulden Yumuk  12 , Nazim Can Demircan  12 , Abdilkerim Oyman  13 , Teoman Sakalar  14 , Fatih Karatas  15 , Hacer Demir  16 , Ayse Irem Yasin  17 , Adem Deligonul  2 , Bahar Dakiki  2 , Mehmet Refik Goktug  2 , Okan Avcı  18 , Seher Yildiz Tacar  18 , Nazım Serdar Turhal  19 , Gülhan Ipek Deniz  20 , Turgut Kacan  1 , Erdem Cubukcu  2 , Türkkan Evrensel  2
Affiliations

Can Cytoreductive Nephrectomy Improve Outcomes of Nivolumab Treatment in Patients with Metastatic Clear-Cell Renal Carcinoma?

Birol Ocak et al. Curr Oncol. .

Abstract

Background: This study aimed to investigate the effect of cytoreductive nephrectomy (CN) on the survival outcomes of nivolumab used as a subsequent therapy after the failure of at least one anti-vascular endothelial growth factor (VEGF) agent in patients with metastatic clear-cell renal-cell carcinoma (ccRCC). Methods: We included 106 de novo metastatic ccRCC patients who received nivolumab after progression on at least one anti-VEGF agent. Multivariate Cox regression analysis was performed to investigate the factors affecting survival in patients receiving nivolumab. Results: Of the 106 de novo metastatic ccRCC patients, 83 (78.3%) underwent CN. There were no statistical differences between the two groups in terms of age, gender, Eastern Cooperative Oncology Group (ECOG) score, tumor size, International Metastatic RCC Database Consortium (IMDC) risk group, number of previous treatment lines, first-line anti-VEGF therapy, or metastasis sites (p = 0.137, p = 0.608, p = 0.100, p = 0.376, p = 0.185, p = 0.776, p = 0.350, and p = 0.608, respectively). The patients who received nivolumab with CN had a longer time to treatment discontinuation (TTD) [14.5 months, 95% confidence interval (CI): 8.6-20.3] than did those without CN 6.7 months (95% CI: 3.9-9.5) (p = 0.001). The median overall survival (OS) was 22.7 months (95% CI: 16.1-29.4). The patients with CN had a median OS of 22.9 months (95% CI: 16.3-29.4), while those without CN had a median OS of 8.1 months (95% CI: 5.6-10.5) (p = 0.104). In the multivariate analysis, CN [hazard ratio (HR): 0.521; 95% CI: 0.297-0.916; p = 0.024] and the IMDC risk score (p = 0.011) were statistically significant factors affecting TTD; however, the IMDC risk score (p = 0.006) was the only significant factor for overall survival. Conclusions: Our study showed that the TTD of nivolumab was longer in metastatic ccRCC patients who underwent cytoreductive nephrectomy.

Keywords: clear-cell renal-cell carcinoma; cytoreductive nephrectomy; nivolumab; survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A diagram of the study design. RCC: renal-cell carcinoma, ccRCC: clear-cell renal-cell carcinoma.
Figure 2
Figure 2
Effect of cytoreductive nephrectomy on time to treatment discontinuation in patients receiving nivolumab. TDT: time to treatment discontinuation, CN: cytoreductive nephrectomy.
Figure 3
Figure 3
Impact of IMDC risk groups on time to treatment discontinuation in patients receiving nivolumab. IMDC: International Metastatic Renal Cell Carcinoma Database Consortium, TDT: time to treatment discontinuation.
Figure 4
Figure 4
Impact of IMDC risk groups on overall survival in patients receiving nivolumab. IMDC: International Metastatic Renal Cell Carcinoma Database Consortium, OS: overall survival.
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