The role of metastatectomy in metastatic renal cell cancer following the treatment with a molecular targeted agent.

Abstract

e15053 Background: The recent treatment shift for metastatic clear cell renal cell cancer is the use of molecular targeted agents. A complete response is rare, more common is prolonged stability or partial response. For those patients with metastatic sites that are surgically accessible who have demonstrated stability or regression, are evaluated for the role of surgery. The purpose is to define the role of metastatectomy following the treatment with a molecular targeted agent. We will report on the safety, whether it improves the progression-free survival and overall survival, in patients who have undergone a metastatectomy following a molecular targeted agent. Methods: Nineteen patients with metastatic clear cell renal cell cancer were treated with a molecular targeted agent [RAD001 mammalian target of rapamycin (mTOR) inhibitor) or sorafenib (tyrosine kinase inhibitor)] and were evaluated following prolonged stability or a sustained partial response for surgical resection. Evaluation consisted of the following; whether surgical complete resection was achieved, progression free survival post surgery, and overall survival. Those patients with viable tumor were offered 6 months of adjuvant therapy using the same molecular targeted agent prior to metastatectomy. Results: Fourteen of nineteen patients (74%) achieved surgical complete resection. All patients achieved negative surgical margins. Three of nineteen patients (16%) had post operative complications associated with bleeding. There was no associated post operative mortality. 37% of the patients have not had recurrent disease ranging from 6 to 19 months. Those that recurred, the majority were within 6 months. Seventeen of the nineteen (89%) remain alive to date. Conclusions: Following the use of molecular targeted agents, complete surgical resection can be achieved and is safe. Patients have demonstrated a delay in the onset of development of new metastatic disease. This data provides the foundation for a prospective study to evaluate the role of metastatectomy in metastatic renal cell cancer patients treated with a molecular targeted agent in order to establish criteria for surgical resection. No significant financial relationships to disclose.