Radical Nephrectomy Improves Survival in Metastatic Kidney

Radical nephrectomy combined with imminotherapy improves survival in individuals with metastatic kidney cancer.

According to an article published in The Journal of Urology, a radical nephrectomy, or complete removal of a kidney, plus interferon improves survival compared to interferon alone in the treatment of metastatic kidney cancer.1

The kidneys are a pair of bean shaped organs located on each side of the spine. The kidneys filter the blood and eliminate waste in the urine through a complex system of filtration tubules. All of the blood in the body passes through the kidneys approximately 20 times an hour. Renal cell cancer (RCC) is an uncommon form of cancer that is most often characterized by the presence of cancer cells in the lining of the filtration tubules of the kidney. Metastatic RCC refers to cancer that has spread outside the kidneys to distant locations in the body. The prognosis for patients with metastatic RCC following standard therapy is poor and novel treatment strategies are being evaluated to establish optimal care.

A radical nephrectomy, or complete removal of the involved kidney, adjacent fat, adrenal gland and/or any involved lymph nodes or major vasculature, is a standard surgical procedure for RCC that is confined to the kidney. More recently, a radical nephrectomy is also being utilized for patients with stage IV, or metastatic RCC. Results from clinical trials have demonstrated that a radical nephrectomy appears to improve survival in patients with metastatic RCC.2,3 Standard treatment for metastatic RCC typically also includes interferon, a substance naturally produced in the body that stimulates the immune system to initiate an attack against the cancer.

Researchers from the Southwest Oncology Group (SWOG) and the European Organization for the Research and Treatment of Cancer Genitourinary Group recently conducted 2 clinical trials further evaluating treatment utilizing a radical nephrectomy in patients with metastatic RCC. Together, these 2 trials included 331 patients who were treated with either a radical nephrectomy plus interferon, or interferon only. Overall, patients treated with a nephrectomy had an overall average duration of survival of 13.6 months, compared to only 7.8 months for those treated with interferon alone. The size of cancer, or the sites in the body to which the cancer had spread did not have an impact on the survival benefit of a radical nephrectomy in these patients.

Radical Nephrectomy Prior to Interferon Improves Survival for Metastatic Renal Cell Cancer

Another study published in Lancet supports radical nephrectomy prior to treatment with interferon because it significantly delays cancer progression and improves survival over interferon alone for patients with metastatic renal cell cancer. (4)

Thos multi-institutional clinical trial was conducted to further evaluate the efficacy of treatment involving a radical nephrectomy prior to interferon in 85 patients with metastatic renal cell cancer. In this trial, half of the patients were treated with a radical nephrectomy prior to interferon and the other half were treated with interferon alone. Following treatment, the average time to the progression of cancer was 5 months for patients treated with a radical nephrectomy plus interferon, compared with 3 months in the group of patients treated with interferon alone. The average survival time following treatment was 17 months in the group patients treated with surgery, compared with only 7 months for patients treated with interferon only. Five patients who were treated with surgery and interferon achieved a complete disappearance of their cancer, compared with one patient treated only with interferon.

Although this is a controversial issue, the results from this small trial also indicate a significant improvement in survival duration for patients with metastatic renal cell cancer treated with a radical nephrectomy prior to interferon, compared with interferon alone. Future clinical trials further evaluating this treatment regimen are warranted for patients with this disease. Patients with metastatic renal cell cancer may wish to speak with their physician about the risks and benefits of treatment including a radical nephrectomy plus interferon or the participation in a clinical trial evaluating this treatment regimen or other promising therapies.

The researchers concluded that these results provide further evidence that a radical nephrectomy significantly improves survival in patients with metastatic RCC. They also stated that the use of more aggressive immunotherapy or other novel therapeutic agents may further improve survival in patients undergoing a nephrectomy. Patients with metastatic RCC may wish to speak with their physician about the risks and benefits of a radical nephrectomy or the participation in a clinical trial evaluating other novel therapeutic approaches.

References

  1. Flanigan RC, Mickisch G, Silverster R, et al. Cytoreductive Nephrectomy in Patients with Metastatic Renal Cancer: A Combined Analysis. Journal of Urology. 2004;17:1071-1076.

  2. Mickisch GH, van Poppel H, de Prijck L, et al. Radical Nephrectomy plus Interferon-Alfa-Based Immunotherapy Compared with Interferon Alone in Metastatic Renal-Cell Cancer. The Lancet. 2001;358:948-949.

  3. Flanigan RC, salmon SE. Blumenstein BA, et al. Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer. The New England Journal of Medicine. 2001;345:1699-1700.

  4. The Lancet, Vol 358, No 9286, pp 966-970, 2001

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