You have accessJournal of UrologyCME1 Apr 2023MP28-03 CYTOREDUCTIVE NEPHRECTOMY FOLLOWING IMMUNE CHECKPOINT INHIBITORS IS SAFE AND FACILITATES TREATMENT FREE INTERVALS Daniel Shapiro, Ali Ghasemzadeh, Jose Karam, Logan Zemp, Viraj Master, Wade Sexton, Facundo Davaro, Benjamin Schmeusser, Dattatraya Patil, Surena Matin, Philippe Spiess, and E. Jason Abel Daniel ShapiroDaniel Shapiro More articles by this author , Ali GhasemzadehAli Ghasemzadeh More articles by this author , Jose KaramJose Karam More articles by this author , Logan ZempLogan Zemp More articles by this author , Viraj MasterViraj Master More articles by this author , Wade SextonWade Sexton More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Benjamin SchmeusserBenjamin Schmeusser More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Surena MatinSurena Matin More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Immune checkpoint inhibitors (ICI) are first line therapy for metastatic renal cell carcinoma (mRCC). Additionally, cytoreductive nephrectomy (CN) is often performed after initial ICI therapy. Few data exist on the effect of upfront ICI therapy on perioperative CN outcomes. This study evaluated intraoperative and postoperative CN outcomes for patients who underwent upfront ICI. METHODS: Four tertiary level institutions retrospectively evaluated perioperative outcomes among consecutive patients who received upfront ICI followed by deferred CN. Intraoperative and postoperative outcomes were tabulated. Complications were graded according to the Clavien-Dindo complication scale with complications grade ≥III considered to be high grade. RESULTS: A total of 75 patients were identified between 2017-2022. Clinical characteristics are listed in Table 1. The patients were generally healthy with good performance status. Majority were IMDC intermediate risk (71%) and received ipilimumab and nivolumab therapy (90%). Median time on ICI therapy was 3 months (IQR 2-9). The majority underwent an open radical nephrectomy (71%) of which 13% had an IVC thrombus. The median operative time was 177 minutes (IQR 112-239) with median blood loss of 195cc (IQR 100-400). Three patients had intraoperative complications. Median length of stay was 4 days. The 90-day complication rate was 19/75 (25%), of which only 2/75 (3%) were high grade (Clavien ≥III). This included one patient who aspirated and required intubation and another patient with an upper GI bleed requiring endoscopy. None died within 90 days, and 1 patient was readmitted within 30 days. Regarding postoperative therapy, 36/75 (48%) were rendered with minimal or no residual disease and have not restarted ICI therapy at last follow-up. Of those that did restart therapy, the median time to restart ICI was 34 days (IQR 23-56 days). CONCLUSIONS: In this select group of consecutive patients with good PS treated at tertiary level hospitals, deferred CN following ICI therapy was safe with rare incidence of high-grade complications. Additionally, many patients were rendered with minimal residual disease allowing them to be placed on surveillance thus avoiding the toxicity of further ICI therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e369 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Shapiro More articles by this author Ali Ghasemzadeh More articles by this author Jose Karam More articles by this author Logan Zemp More articles by this author Viraj Master More articles by this author Wade Sexton More articles by this author Facundo Davaro More articles by this author Benjamin Schmeusser More articles by this author Dattatraya Patil More articles by this author Surena Matin More articles by this author Philippe Spiess More articles by this author E. Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...