Presenter: Robert Charles Flanigan Affiliation: Southwest Oncology Group
Background: Metastatic renal cancer has a poor prognisis and is
resistant to chemotherapy. A number of case series
have reported a
benefit to neprhectomy in patients with metastatic
renal cancer. This
prospective randomized trial was designed to
nephrectomy prior to systemic therapy with
interferon prolongs survival
Materials and Methods:
246 patients with operable metstatic renal
carcinoma and SWOG
performance status 0 - 1 were randomized to one of
1. Neprhectomy plus alpha interferon
2. Alpha interferon without nephrectomy.
Interferon 5 Million Units was administered Q M-
W-F and continued
The study was well balanced between arms for age,
gender and race.
However, there were more patients with better
performance status in the
Median survival was 12.5 months vs. 8.1 months in
favor of the
nephrectomy group (p = 0.006)
The 1-year actuarial survival was 50% vs. 37%,
again in favor of
There was a poor response rate from interferon in
both arms (3% in
There is a clear survival advantage to
nephrectomy prior to biologic
therapy based on the results of this trial.
This represents a new algorithm for the
management of metastatic renal
call carcinoma in patients with good performance
This study shows a greater than 50% improvement
in survival for
patients with metastatic disease who undergo
The performance status can have a great imact on
survival, and the
imbalance between the two arms of this trial may
have contributed to the
differences in outcome.
Fortunately, a recent EORTC trial with similar
design (presented last
month at the American Urologic Association meeting)
showed a survival
advantage also in favor of nephrectomy.
Based on these two trials, surgery can be
considered in select
patients with good performance status when they
present with metastatic
Further evaluation of appropriate systemic
therapy is warranted.
Nov 24, 2014 - In patients with advanced or metastatic renal cell carcinoma with poor prognosis who are not usually entered into clinical trials, sunitinib significantly prolongs progression-free and overall survival and is well-tolerated, according to a study published online July 16 in The Lancet Oncology.