Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer

Flanigan, Robert C.; Salmon, Sydney E.; Blumenstein, Brent A.; Bearman, Scott I.; Roy, Vivek; McGrath, Patrick C.; Caton, J. R.; Munshi, Nikhil C.; Crawford, E. David

doi:10.1056/nejmoa003013

Cited by 1,544 publications

(845 citation statements)

References 22 publications

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“…Also, 39% of patients did not have nephrectomy. This is higher than figures for nephrectomy prior to systemic therapy and is probably due to patients with primary progressive disease not have nephrectomy 2 . It appears sensible not to perform nephrectomy on these patients with primary progressive metastatic disease, as it spares them a procedure which causes morbidity but may not significantly improve outcome.…”

Section: Discussionmentioning

confidence: 65%

“…The current standard of care is cytoreductive nephrectomy followed by vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI) 1 . The use of nephrectomy in metastatic disease was established prior to the development of VEGF TKIs 2,3 . This sequence has not been prospectively evaluated in the era of VEGF targeted therapy, although large recent retrospective series suggest nephrectomy is still associated with a survival benefit in unselected patients 4 .…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Pazopanib Therapy Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer

et al. 2016

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Pazopanib Therapy Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer

et al. 2016

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“…However, many people felt that the results were achieved due to selection bias while some felt that CRN could have some biological effect on patient survival. The EORTC in their study-EORTC 30947-and the SWOG in their study-SWOG 8949-studied the issue of CRN with immunotherapy versus immunotherapy alone by using IFN-a2b [7,8]. Both trials recruited histologically confirmed clear cell mRCC with metastases beyond regional lymphatics, absence of brain metastases, inferior vena cava (IVC) thrombus below hepatic veins, if present.…”

Section: Discussionmentioning

confidence: 99%

“…Interferon alpha 2-b was considered safer than interleukin-2; the latter had high toxicity profile, had to be administered in the hospital setting, and was costly. Two major randomised controlled trials (European Organisation for Research and Treatment of Cancer (EORTC) 30947 and Southwest Oncology Group (SWOG) 8949) and their combined analysis showed significant survival benefit when patients with metastatic RCC (mRCC) were treated with cytoreductive nephrectomy and interferon alpha 2-b versus interferon alpha 2-b alone [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Khochikar

2016

Indian J Surg Oncol

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Renal cell carcinoma accounts for 3% of adult solid malignant tumours. Approximately 25% of the patients present with metastatic disease at presentation. In the era of immunotherapy (interferon alpha-2b and interleukin-2), studies showed significant survival benefit with cytoreductive nephrectomy (CRN) followed by interferon alpha-2b than interferon alpha 2-b alone. Introduction of targeted therapies (vascular endothelial growth factor receptor-tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors) in 2005 generated a great interest in the management of metastatic renal cell carcinoma (mRCC) as these drugs exhibited tumour shrinkage in the primary tumour as well as in the metastatic site/s. Though there is no level 1 evidence, many studies have shown the usefulness of cytoreductive nephrectomy along with targeted therapy as against to targeted therapy alone. This review is aimed at the rationale behind the cytoreductive nephrectomy in mRCC, the current evidence and what is in store for the future. A detailed search on the management of mRCC was carried out on MEDLINE, Embase, CANCERLIT and Cochrane Library databases using the key words Bcytoreductive nephrectomy^, Bimmunotherapy^and Btargeted therapy^since 1980 till 2015. Original articles, review articles, monograms, book chapters on metastatic renal cancer and textbooks on urologic oncology, oncology and urology were reviewed. Various international guidelines on this issue were also studied. An identical search was performed using the American Society of Clinical Oncology Abstract database. Trials in the progress or recently completed that were relevant to this paper were identified through clinicaltrials.gov. The latest information for new articles ahead of publication was last accessed in November 2015. CRN has remained an integral part to the management of metastatic renal cell carcinoma mainly for the patients with good performance status, life expectancy of more than 12 months and in the absence of adverse prognostic factors. It had shown measurable survival benefit in the era of immunotherapy (CRN + immunotherapy vs. immunotherapy alone). In the era of targeted therapy, many studies have shown significant survival benefit with CRN + targeted therapy. However, there is no clear level 1 evidence to support this. The ongoing trials (CARMENA and European Organisation for Research and Treatment of Cancer SURTIME) would perhaps guide us in the way in which we should manage mRCC disease in the future. Maybe we may find some answers on the issues of the effectiveness of targeted therapy, the timing of CRN and sequencing these treatment arms once the results of these ongoing and future trials are through.

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“…Recently FDA approved oral agents for metastatic RCC offer improved progression free and overall survival, but essentially no complete responses 2 . Aggressive treatment with radical nephrectomy and immunotherapy has also been shown to provide a survival benefit in metastatic RCC patients 3,4 , and retrospective data suggest that five-year survival rates were improved when IL-2 was used as adjunctive immunotherapy instead of IFN-(19.6% vs. 10%) 5 . Although the administration of IL-2 offers the possibility of durable CRs, it is associated with considerable toxicity, while only a small subset of patients respond to therapy 3 .…”

Section: Purposementioning

confidence: 99%

Proteomic Identification of Interleukin-2 Therapy Response in Metastatic Renal Cell Cancer

et al. 2008

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Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer

Abstract: Nephrectomy followed by interferon therapy results in longer survival among patients with metastatic renal-cell cancer than does interferon therapy alone.

Cited by 1,544 publications

References 22 publications

Safety and Efficacy of Pazopanib Therapy Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer

Safety and Efficacy of Pazopanib Therapy Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Proteomic Identification of Interleukin-2 Therapy Response in Metastatic Renal Cell Cancer

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