Yoshino Maki, Ishihara Hiroki, Nemoto Yuki, Nakamura Kazutaka, Nishimura Koichi, Tachibana Hidekazu, Fukuda Hironori, Toki Daisuke, Yoshida Kazuhiko, Kobayashi Hirohito, Iizuka Junpei, Shimmura Hiroaki, Hashimoto Yasunobu, Tanabe Kazunari, Kondo Tsunenori, Takagi Toshio
Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Oct 6;52(10):1208-1214. doi: 10.1093/jjco/hyac099.
To explore the therapeutic role of deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab.
Forty-one patients with synchronous metastatic renal cell carcinoma who received nivolumab plus ipilimumab as first-line systemic therapy at our affiliated institutions were retrospectively evaluated. We focused on the prognosis, including tumor responses in primary kidney and metastatic lesions in patients treated with deferred cytoreductive nephrectomy. In addition, the overall survival according to nephrectomy status (i.e. deferred cytoreductive nephrectomy vs. upfront cytoreductive nephrectomy vs. without cytoreductive nephrectomy) was compared.
During a median follow-up period of 12.0 months, seven (30%) patients received deferred cytoreductive nephrectomy at a median time of 10.4 months after nivolumab plus ipilimumab initiation. All the patients showed tumor shrinkage in their primary kidney lesions, including six (86%) patients with ≥30% of shrinkage. Metastatic lesions were also shrunk by ≥30% in six (86%) patients, including two (29%) obtaining complete response. At the last time of follow-up, three (43%) patients were disease-free. The overall survival rate after nivolumab plus ipilimumab initiation tended to be higher in patients with deferred cytoreductive nephrectomy compared with those with upfront cytoreductive nephrectomy (1-year survival rate: 100% vs. 72.4%, P = 0.0587) and those without cytoreductive nephrectomy (vs. 58.2%, P = 0.0613).
The present retrospective data showed that deferred cytoreductive nephrectomy had the potential to exert a therapeutic effect in a subset of patients who obtained favorable tumor responses to nivolumab plus ipilimumab for a certain period. Prospective randomized clinical trials are needed to confirm the prognostic impact of deferred cytoreductive nephrectomy after frontline immunotherapy in synchronous metastatic renal cell carcinoma.
探讨延迟性减瘤性肾切除术在接受纳武单抗加伊匹单抗治疗的转移性肾细胞癌患者中的治疗作用。
对在我们附属机构接受纳武单抗加伊匹单抗作为一线全身治疗的41例同步转移性肾细胞癌患者进行回顾性评估。我们关注预后情况，包括接受延迟性减瘤性肾切除术患者的原发性肾脏肿瘤反应和转移性病变情况。此外，比较了根据肾切除术状态（即延迟性减瘤性肾切除术与 upfront 减瘤性肾切除术与未进行减瘤性肾切除术）的总生存期。
在中位随访期12.0个月期间，7例（30%）患者在开始使用纳武单抗加伊匹单抗后中位10.4个月接受了延迟性减瘤性肾切除术。所有患者的原发性肾脏病变均出现肿瘤缩小，其中6例（86%）患者缩小≥30%。6例（86%）患者的转移性病变也缩小≥30%，其中2例（29%）获得完全缓解。在最后一次随访时，3例（43%）患者无疾病进展。与 upfront 减瘤性肾切除术患者（1年生存率：100%对72.4%，P = 0.0587）和未进行减瘤性肾切除术患者（对58.2%，P = 0.0613）相比，接受延迟性减瘤性肾切除术患者在开始使用纳武单抗加伊匹单抗后的总生存率有升高趋势。
目前的回顾性数据表明，延迟性减瘤性肾切除术有可能在一部分对纳武单抗加伊匹单抗在一定时期内获得良好肿瘤反应的患者中发挥治疗作用。需要进行前瞻性随机临床试验来证实延迟性减瘤性肾切除术在同步转移性肾细胞癌一线免疫治疗后的预后影响。
