Cytoreduction Nephrectomy in Metastatic Renal Cancer: The Results ofSouthwest Oncology Group Trial 8949
Presenter: Robert Charles Flanigan
Affiliation: Southwest Oncology Group
Metastatic renal cancer has a poor prognisis and is classically highly 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 determine whether nephrectomy prior to systemic therapy with interferon prolongs survival
- 246 patients with operable metstatic renal carcinoma and SWOG performance status 0 - 1 were randomized to one of two arms: 1. Neprhectomy plus alpha interferon 2. Alpha interferon without nephrectomy.
- Interferon 5 Million Units was administered Q M- W-F and continued until progression.
- The study was well balanced between arms for age, gender and race. However, there were more patients with better performance status in the nephrectomy arm.
- 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 nephrectomy.
- There was a poor response rate from interferon in both arms (3% in both arms)
- 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 status
- This study shows a greater than 50% improvement in survival for patients with metastatic disease who undergo neprhrectomy.
- 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 disease.
- Further evaluation of appropriate systemic therapy is warranted.