How Did We Obtain Complete Remission in Patients Who Had Metastatic Renal Cancer in the Era of Targeted Therapies?

Abstract

The management of metastatic renal cell carcinoma (mRCC) has been transformed by the use of targeted therapies, ablative therapies and improved surgical techniques. The objective of this study was to identify therapeutic strategies that resulted in complete remission (CR) and to assess survival of patients in CR. In a prospective database, we included all patients treated for mRCC at a university hospital between 2007 and 2015. CR was defined as the absence of metastasis after a full-body computed tomographic scan. We treated 77 patients with mRCC and experienced a CR in 22 (29%) patients. Patients in CR had, respectively, synchronous and metachronous metastases in 7 (32%) and 15 (68%) cases and unique and multiple metastases in 4 (18%) and 18 (82%) cases. All patients were treated with cytoreductive nephrectomy and 21 (96%) had metastasectomy or percutaneous ablation of their metastases. One patient had a CR after systemic treatment with sunitinib. After a median (range) follow-up since metastatic diagnosis of 35 (1-89) months, 12 patients (55%) had disease recurrence. The median (range) duration of CR before recurrence was 14 (1-39) months. After recurrence, a new CR was obtained in 7 patients (58%). At the end of follow-up, 16 patients (73%) were still in CR, 5 (23%) were undergoing medical treatment, and 1 patient died during the postoperative course. In the era of targeted-therapies, CRs were obtained with multimodal treatment of metastatic kidney cancer. All patients in CR had a nephrectomy and almost all of them had multiple metastasectomies.