Pd18-08 Tumor Size Reduction (≥10%) Resulting From Pre-Surgical Systemic Therapy Predicts Improved Survival Following Cytoreductive Nephrectomy

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-08 TUMOR SIZE REDUCTION (≥10%) RESULTING FROM PRE-SURGICAL SYSTEMIC THERAPY PREDICTS IMPROVED SURVIVAL FOLLOWING CYTOREDUCTIVE NEPHRECTOMY Daniel D. Shapiro, Jose A. Karam, Viraj A. Master, Philippe E. Spiess, Charles C. Peyton, Brendan Dolan, R. Barry Sirard, Nicholas D. Robertson, Kartik R. Patel, Amber Jani, Dattatraya Patil, Edouard Nicaise, Brandon J. Manley, Wade J. Sexton, Glenn O. Allen, Surena F. Matin, and Edwin J. Abel Daniel D. ShapiroDaniel D. Shapiro , Jose A. KaramJose A. Karam , Viraj A. MasterViraj A. Master , Philippe E. SpiessPhilippe E. Spiess , Charles C. PeytonCharles C. Peyton , Brendan DolanBrendan Dolan , R. Barry SirardR. Barry Sirard , Nicholas D. RobertsonNicholas D. Robertson , Kartik R. PatelKartik R. Patel , Amber JaniAmber Jani , Dattatraya PatilDattatraya Patil , Edouard NicaiseEdouard Nicaise , Brandon J. ManleyBrandon J. Manley , Wade J. SextonWade J. Sexton , Glenn O. AllenGlenn O. Allen , Surena F. MatinSurena F. Matin , and Edwin J. AbelEdwin J. Abel View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After pre-surgical systemic therapy for metastatic RCC (mRCC), the decision to proceed with cytoreductive nephrectomy (CN) is complex. This study evaluated prognostic factors associated with overall survival (OS) including radiographic response in the primary and metastatic sites to pre-surgical targeted and immune checkpoint inhibitor (IO) therapies. METHODS: Data for synchronous mRCC patients treated with pre-surgical systemic therapy followed by CN at 5 institutions from 2010-2023 were analyzed. Tumors were measured per RECIST v1.1 before systemic therapy and prior to CN to quantify the response to therapy. Patients were grouped according to type of pre-surgical systemic therapy (targeted vs IO). Tumor measurements included maximum primary tumor (PT) diameter, sum of metastatic tumor diameters, and sum of PT+metastatic diameters. OS was estimated by the Kaplan Meier method. Multiple size threshold changes were evaluated for prognostic ability. RESULTS: 272 patients had systemic therapy prior to CN (N=174 received pre-surgical targeted therapy only) and (N=98 received any pre-surgical IO) with median follow-up of 51 months overall. Median OS was longer in the pre-surgical IO cohort than targeted therapy cohort (median 49 vs. 27 months, p0.05). Pre-surgical IO patients had greater PT+metastatic burden reduction vs targeted therapy (median 18% vs 13%, p=0.01). Also, more pre-surgical IO patients achieved a partial response per RECIST (34% vs 19%, p=0.01) (Figure 1C). After multivariable analysis adjusting for pre-surgical systemic therapy type, IMDC risk group, grade and stage, ≥10% total PT+metastatic size reduction was significantly and independently associated with improved OS (Hazard ratio 0.66, p=0.02) (Figure 1D). CONCLUSIONS: Pre-surgical IO therapy is associated with greater tumor size reduction compared to targeted therapies. Among all types of systemic therapies, ≥10% decrease in total tumor burden was prognostic for improved survival following CN. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e435 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daniel D. Shapiro More articles by this author Jose A. Karam More articles by this author Viraj A. Master More articles by this author Philippe E. Spiess More articles by this author Charles C. Peyton More articles by this author Brendan Dolan More articles by this author R. Barry Sirard More articles by this author Nicholas D. Robertson More articles by this author Kartik R. Patel More articles by this author Amber Jani More articles by this author Dattatraya Patil More articles by this author Edouard Nicaise More articles by this author Brandon J. Manley More articles by this author Wade J. Sexton More articles by this author Glenn O. Allen More articles by this author Surena F. Matin More articles by this author Edwin J. Abel More articles by this author Expand All Advertisement PDF downloadLoading ...