Elective Cytoreductive Nephrectomy After Checkpoint Inhibitor Immunotherapy in Patients With Initially Unresectable Metastatic Clear Cell Renal Cell Carcinoma.

Abstract

Abstract Background Combination checkpoint inhibitor immunotherapy has recently become a new frontline standard of care for metastatic renal cell carcinoma (mRCC). Previously published data has demonstrated a survival benefit of cytoreductive nephrectomy (CN) in the interferon era, but the utility of CN in conjunction with the use of tyrosine kinase inhibitors (TKIs) has been controversial. Patients In the current case series, we report on five patients with IMDC intermediate- or poor-risk initially unresectable metastatic renal cell carcinoma who successfully underwent CN. Results All patients received induction combination checkpoint inhibitor immunotherapy (CPI) ipilimumab-nivolumab with or without pembrolizumab-axitinib. Three patients underwent robotic CN, and one patient underwent open and laparoscopic CN, respectively. Three of the five patients were found to have significant fibrosis and desmoplastic reaction at the time of nephrectomy, requiring surgical expertise and increased operative time. Conclusions Herein we highlight the feasibility of this approach and the post-CPI surgical challenge of CN. The role of CN in patients receiving systemic therapy with CPI is not yet defined and is quickly evolving.