Surgery Provides Overall Survival Benefit in Patients with Advanced Genitourinary Cancers
Urologists and medical oncologists at Brigham and Women’s Hospital (BWH) and Dana-Farber Brigham Cancer Center (DFBCC) have led several registry studies demonstrating overall survival benefit in patients with advanced genitourinary cancers, including metastatic urothelial cancer of the bladder and metastatic renal cell carcinoma. Quoc-Dien Trinh, MD, a urologic surgeon in the Division of Urology at BWH and Lank Center for Genitourinary Oncology at DFBCC, and Toni K. Choueiri, MD, Director of the Lank Center for Genitourinary Oncology at DFBCC, were senior authors of the studies, which were published in the Journal of Clinical Oncology.
“These studies show that removing the primary tumor in the setting of metastatic disease, even with the availability of appropriate targeted and other systemic therapies, can be beneficial in two genitourinary cancers that carry a poor prognosis in advanced stages,” said Dr. Trinh.
Surgery in Metastatic Urothelial Cancer of the Bladder
This study of 3,753 patients with primary metastatic urothelial carcinoma of the bladder within the National Cancer Data Base evaluated outcomes among those who received multiagent systemic chemotherapy combined with high-intensity versus conservative local treatment (J Clin Oncol. 2016 Jun 6.). High-intensity treatment included patients who received radical cystectomy or = 50 Gy of radiation therapy delivered to the bladder. The conservative local treatment group (92 percent of patients) included those who received no local treatment, transurethral resection of the bladder tumor alone, or < 50 Gy of radiation therapy. The researchers found that the median overall survival was significantly longer in the high-intensity group (14.92 months) compared with the conservative group (9.95 months).
“We have seen virtually no change in mortality rates among patients with metastatic bladder cancer over the past two decades,” said Dr. Trinh, corresponding author of the study. “We hope that our study may open the door to large-scale randomized clinical trials to assess the benefit of this strategy in patients with advanced bladder cancer.”
Cytoreductive Nephrectomy in Advanced Renal Cell Carcinoma
This study used the National Cancer Data Base to identify 15,390 patients with metastatic renal cell carcinoma who underwent targeted therapies between 2006 and 2013 (J Clin Oncol. 2016 Sep 20;34(27):3267-75.). Of these patients, 5,374 (35 percent) underwent cytoreductive nephrectomy. The median overall survival of patients who underwent cytoreductive nephrectomy was 17.1 months compared with 7.7 months among patients who did not receive cytoreductive nephrectomy. Cytoreductive nephrectomy was only performed in three of 10 patients with metastatic renal cell carcinoma who were receiving targeted therapy. Researchers found that patients who were younger, privately insured, treated at an academic center, and had lower tumor stage were more likely to undergo cytoreductive nephrectomy.
“This study may help to answer previously unanswered questions about whether there has been a decrease in cytoreductive nephrectomy since the introduction of targeted therapies, whether the procedure improves survival in patients being treated with targeted therapy, and whether some subsets of patients are more likely than others to receive the surgery,” said corresponding author Dr. Choueiri.
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