Surgery in Metastatic RCC Lee Lui Shiong Senior Consultant and Head of Service, Sengkang General Hospital Senior Consultant, Department of Urology, Singapore General Hospital Visiting Consultant, National Cancer Centre Clinical Senior Lecturer Yong Loo Lin School of Medicine Adjunct Asst Professor, Dukes-GMS School of Medicine [email protected]
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surgery in metastatic RCC - European Society for Medical ...€¦ · Cytoreductive Nephrectomy in Patients With Metastatic Renal Cancer: A Combined Analysis The Journal of Urology,
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Surgery in Metastatic RCC
Lee Lui ShiongSenior Consultant and Head of Service, Sengkang General Hospital
Senior Consultant, Department of Urology, Singapore General Hospital
Visiting Consultant, National Cancer Centre
Clinical Senior Lecturer Yong Loo Lin School of Medicine
Adjunct Asst Professor, Dukes-GMS School of Medicine
Fig. 1. Duration of survival in combined SWOG and EORTC trials. O, observation. N, nephrectomy
13.8 vs 7.6 months
7% CR
ROBERT C. FLANIGAN, G. MICKISCH, RICHARD SYLVESTER, CATHY TANGEN, H. VAN POPPEL, E. DAVID CRAWFORD
Cytoreductive Nephrectomy in Patients With Metastatic Renal Cancer: A Combined Analysis
The Journal of Urology, Volume 171, Issue 3, 2004, 1071–1076
• Phase III
• CN+Sutent vs Sutent alone
• sunitinib - 50 mg daily , 28 on /14 off every 6 weeks
• primary end point overall survival
Planned n=576
• Did not recruit to size
• Weighted towards poor risk patients
• Median OS
– 18 month Sutent
– 13 months CN + Sutent
• Cytoreductive in these patients not likely to be
beneficial
Why does CN work?
• Primary tumor ( immunologic ‘sink’)
• Reducing systemic burden of disease
• Reducing production of angiogenic factors
• J. Urol. 144; 1990: 614–617
• J. Urol. 147; 1992: 24–30
• Int. J. Urol. 2001; 275–281
• Am. J. Pathol. 158,2001: 735–743
Utilisation of CN
Tsao, C et al. World J Urol (2013) 31: 1535
Poor risk have limited incremental OS benefit
with CN
No CN CN
• Good prognosis – zero
• Intermediate – 1- 2
• Poor - ≥3
Median OS 43.2 mths (95%CI 31.4-50.1)
Median OS 22.5 mths (95%CI 18.7- 25.1)
Median OS 7.8 mths (95%CI 6.5- 9.7)
Lee LS et al. 2012 Nat. Rev. Urol. Predictive models for the practical management of renal cell
carcinoma
Association of percentage of tumour burden removed with debulking nephrectomy and progression‐‐‐‐free survival in patients with metastatic renal cell carcinoma treated with
Computed tomography scans showing partial response in primary tumor of metastatic renal cell carcinoma in patient treated with nivolumab; 48-year-old patient with low-volume but
poorly differentiated disease who developed progressive disease after sunitinib...