Multicenter randomized trial of deferred cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma receiving checkpoint inhibitors: the NORDIC-SUN-Trial

Laura Iisager, Johanne Ahrenfeldt, Frede Donskov, Börje Ljungberg, Axel Bex, Lars Lund, Iben Lyskjær, Niels Fristrup*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Background: Primary tumor removal by cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma patients has been investigated in the context of various treatment regimens. Two randomized controlled trials investigated the role and timing of cytoreductive nephrectomy in the era of targeted therapy and demonstrated that upfront nephrectomy should no longer be performed when patients require systemic therapy. Superiority of checkpoint immunotherapy agents has led to a paradigm change from targeted therapies to immunotherapy-based first-line treatment in patients with primary metastatic disease; thus, deferred cytoreductive nephrectomy needs to be verified in the immunotherapy setting. Furthermore, a need exists for personalizing treatment choices for the individual patient to avoid unnecessary overtreatment. Methods/design: To explore the impact of cytoreductive nephrectomy in this patient group receiving checkpoint immunotherapy, we initiated a randomized, controlled trial comparing deferred cytoreductive nephrectomy with no surgery. The trial integrates a comprehensive translational research program with specimen sampling for biomarker analysis. Discussion: The trial aims to show that deferred cytoreductive nephrectomy improves overall survival in patients with synchronous metastatic renal cell carcinoma, and furthermore, to identify relevant biomarkers for personalized renal cancer management. Trial registration: ClinicalTrials.gov NCT03977571 June 6, 2019.

Original languageEnglish
Article number260
JournalBMC Cancer
Volume24
Number of pages8
ISSN1471-2407
DOIs
Publication statusPublished - 24. Feb 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Keywords

  • Biomarkers
  • Deferred cytoreductive nephrectomy
  • Immunotherapy
  • Synchronous metastatic renal cell carcinoma
  • Translational research
  • Kidney Neoplasms/drug therapy
  • Nephrectomy
  • Humans
  • Carcinoma, Renal Cell/drug therapy
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures

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