Surgery/Immunotherapy Safety Data Reflect “Exciting Era” for RCC Treatment

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Surgery after neoadjuvant immune checkpoint inhibitor therapy for renal cell carcinoma is safe even in challenging surgical cases, according to Jason Scovell, MD.

Treatment with durvalumab (Imfinzi) and tremelimumab-actl (Imjudo) followed by surgery demonstrated safety in patients with locally advanced renal cell carcinoma (RCC), according to study author Jason Scovell, MD, PhD.

In a conversation with CancerNetwork®, Scovell, urology resident at the Cleveland Clinic Glickman Urological & Kidney Institute in Cleveland, Ohio, discussed the safety findings of his study that assessed partial and radical nephrectomy for complex locally advanced RCC following neo-adjuvant immune checkpoint inhibition including durvalumab with or without tremelimumab, which were presented at the 2023 Society of Urologic Oncology (SUO) Annual Meeting.

In the trial, there were no intraoperative complications. A total of 5 patients had positive margins, which were all located at the renal vein wall. Patients were in the hospital for a median of 4 days (interquartile range [IQR], 3-5), and readmission was needed for 3 patients for diabetic ketoacidosis, thrombocytopenia, and pulmonary embolism. Investigators reported 5 30-day and 90-day Clavien complications.

Most patients underwent radical nephrectomy (n = 23) followed by open (n = 17) and minimally invasive (n = 8) procedures. Additionally, renal vein involvement was reported in 6 tumors, and 3 patients required a blood transfusion following surgery.

TRANSCRIPT:

Data analysis is ongoing from an outcome standpoint with the medical oncology team. There's a couple of different outcome measurements as part of this trial, and the primary outcome was looking at the safety and efficacy. What we report on here today is the safety of surgery for patients who have complex locally advanced kidney tumors after they have undergone neoadjuvant immune checkpoint inhibitors. The take home message is that surgery is safe, even for these challenging surgical cases after this therapy.

The big takeaway is we’re really in a new, exciting era. We’re learning a lot about new biology and new opportunities for treatment. We have to stay excited for the types of things that we’ll be able to offer patients in the near term. From what we present today, this is a safe space to perform surgery on complex tumors.

Reference

Zabell J, Rini BI, Krishnamurthi V, et al. Safety of partial and radical nephrectomy for complex locally advanced renal cell carcinoma after neo-adjuvant immune checkpoint inhibition (durvalumab +/- tremelimumab). Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 7.

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