Exploring Therapies in Combination With Cytoreductive Nephrectomy in RCC

Ketan K. Badani, MD, vice chairman of Urology and Robotic Operations for the Mount Sinai Health System and director of Robotic Surgery for Mount Sinai, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt Hospitals, discusses whether cytoreductive nephrectomies are efficacious when combined with immunotherapeutic agents in patients with renal cell carcinoma (RCC).

There are a few trials looking at immuno-oncology agents such as nivolumab (Opdivo). One trial called PROSPER investigated neoadjuvant therapy with nivolumab before surgery for patients with higher risk tumors. Badani says another trial is looking at ipilimumab (Yervoy) and nivolumab together before cytoreductive nephrectomy.

These drugs are being used in place of tyrosine kinase inhibitors such as sunitinib (Sutent) and sorafenib (Nexavar), which are now older treatments in the RCC setting. Now there are many second- and third-line agents that need to be looked at in the same setting. Badani thinks if investigators look at cytoreductive nephrectomy with immune-oncology agents and VEGF agents, there may be completely different results, and even benefit, for higher-risk patients. He hopes that the accrual for these trials is high, since these regimens are usually well-tolerated.