Arnaud Méjean1, Alain Ravaud2, Simon Thezenas3, Christine Chevreau4, Karim Bensalah5, Lionnel Geoffrois6, Antoine Thiery-Vuillemin7, Luc Cormier8, Hervé Lang9, Laurent Guy10, Gwenaelle Gravis11, Frederic Rolland12, Claude Linassier13, Eric Lechevallier14, Stephane Oudard15, Brigitte Laguerre16, Marine Gross-Goupil2, Jean Christophe Bernhard2, Sandra Colas17, Laurence Albiges18, Thierry Lebret19, Jean-Marc Treluyer15, Marc-Olivier Timsit15, Bernard Escudier18. 1. Hôpital Européen Georges-Pompidou, Assistance Publique⬜Hôpitaux de Paris, Paris, France. Electronic address: arnaud.mejean@aphp.fr. 2. Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 3. Institut du Cancer de Montpellier Val d⬢Aurelle, Montpellier, France. 4. Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France. 5. Centre Hospitalier Universitaire de Rennes, Rennes, France. 6. Institut de Cancérologie de Lorraine, VandŜuvre-lès-Nancy, France. 7. Hôpital Jean-Minjoz, Besançon, France. 8. Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France. 9. Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. 10. Gabriel Montpied Hospital, Clermont-Ferrand, France; Clermont Auvergne University, Clermont Ferrand, France. 11. Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France. 12. Institut De Cancérologie De L⬢Ouest, Saint-Herblain, France. 13. Centre Hospitalier Universitaire de Tours, Tours, France. 14. Hôpital de la Conception, Marseille, France. 15. Hôpital Européen Georges-Pompidou, Assistance Publique⬜Hôpitaux de Paris, Paris, France. 16. Centre Eugène Marquis, Rennes, France. 17. Paris Descartes Necker-Cochin Clinical Research Unit, Assistance Publique⬜Hôpitaux de Paris, Paris, France. 18. Gustave Roussy Institute, Villejuif, France. 19. Hôpital Foch, Suresnes, France.
Abstract
BACKGROUND: The CARMENA trial in patients with metastatic renal cell carcinoma (mRCC) demonstrated that treatment with sunitinib alone was noninferior to cytoreductive nephrectomy (CN) followed by sunitinib (nephrectomy⬜sunitinib). OBJECTIVE: The objective of this study was to provide updated overall survival (OS) outcomes of CARMENA and assess whether some subgroups may still benefit from upfront CN. DESIGN, SETTING, AND PARTICIPANTS: CARMENA was a phase III trial in 450 patients with mRCC enrolled from 2009 to 2017. INTERVENTION: Patients in the intention-to-treat population received nephrectomy⬜sunitinib (standard of care [SOC]; n = 226) or sunitinib alone (n = 224). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary endpoint was OS, assessed using an updated data cut-off (October 2018; median OS event-free follow-up, 36.6 mo). Patients were reclassified by risk using International Metastatic RCC Database Consortium (IMDC) criteria. RESULTS AND LIMITATIONS: Sunitinib alone was noninferior to nephrectomy⬜sunitinib (hazard ratio [HR], 0.97; 95% confidence interval, 0.79⬜1.19; p = 0.8) and demonstrated longer median OS (19.8 mo vs 15.6 mo, respectively). For patients with two or more IMDC risk factors, OS was significantly longer with sunitinib alone than with nephrectomy⬜sunitinib (31.2 mo vs 17.6 mo, respectively; HR, 0.65; p = 0.03). For patients with one IMDC risk factor, OS was longer for nephrectomy⬜sunitinib versus sunitinib alone although not significantly (31.4 mo vs 25.2 mo; HR, 1.30; p = 0.2). The post hoc nature of the subgroup analyses may limit their interpretation. CONCLUSIONS: Sunitinib alone was noninferior compared with nephrectomy⬜sunitinib, suggesting that CN should not be considered SOC in patients with mRCC requiring systemic treatment. Certain subgroups, including patients with one IMDC risk factor, may still benefit from upfront CN. PATIENT SUMMARY: We assessed the survival of patients with metastatic kidney cancer in a clinical trial. Patients treated with sunitinib on its own had the same survival as patients who had surgery before sunitinib treatment. We conclude that surgery may not be necessary for some patients with metastatic kidney cancer.
BACKGROUND: The CARMENA trial in patients with metastatic renal cell carcinoma (mRCC) demonstrated that treatment with sunitinib alone was noninferior to cytoreductive nephrectomy (CN) followed by sunitinib (nephrectomy⬜sunitinib). OBJECTIVE: The objective of this study was to provide updated overall survival (OS) outcomes of CARMENA and assess whether some subgroups may still benefit from upfront CN. DESIGN, SETTING, AND PARTICIPANTS: CARMENA was a phase III trial in 450 patients with mRCC enrolled from 2009 to 2017. INTERVENTION: Patients in the intention-to-treat population received nephrectomy⬜sunitinib (standard of care [SOC]; n = 226) or sunitinib alone (n = 224). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary endpoint was OS, assessed using an updated data cut-off (October 2018; median OS event-free follow-up, 36.6 mo). Patients were reclassified by risk using International Metastatic RCC Database Consortium (IMDC) criteria. RESULTS AND LIMITATIONS: Sunitinib alone was noninferior to nephrectomy⬜sunitinib (hazard ratio [HR], 0.97; 95% confidence interval, 0.79⬜1.19; p = 0.8) and demonstrated longer median OS (19.8 mo vs 15.6 mo, respectively). For patients with two or more IMDC risk factors, OS was significantly longer with sunitinib alone than with nephrectomy⬜sunitinib (31.2 mo vs 17.6 mo, respectively; HR, 0.65; p = 0.03). For patients with one IMDC risk factor, OS was longer for nephrectomy⬜sunitinib versus sunitinib alone although not significantly (31.4 mo vs 25.2 mo; HR, 1.30; p = 0.2). The post hoc nature of the subgroup analyses may limit their interpretation. CONCLUSIONS: Sunitinib alone was noninferior compared with nephrectomy⬜sunitinib, suggesting that CN should not be considered SOC in patients with mRCC requiring systemic treatment. Certain subgroups, including patients with one IMDC risk factor, may still benefit from upfront CN. PATIENT SUMMARY: We assessed the survival of patients with metastatic kidney cancer in a clinical trial. Patients treated with sunitinib on its own had the same survival as patients who had surgery before sunitinib treatment. We conclude that surgery may not be necessary for some patients with metastatic kidney cancer.
Authors: Benjamin J Lichtbroun; Arnav Srivastava; Sai Krishnaraya Doppalapudi; Kevin Chua; Eric A Singer Journal: Cancers (Basel) Date: 2022-05-27 Impact factor: 6.575