A DGReview of :"Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer"
New England Journal of Medicine (NEJM)
12/06/2001
By Anne MacLennan
Nephrectomy plus interferon therapy provides longer survival in patients with metastatic renal-call cancer than does interferon therapy alone.
This dramatic finding from a multi-centre study in the United States adds weight to the results of a recent smaller European trial of similar design.
Both studies challenge the long-held view that removal of a primary tumour in patients with evidence of metastasis is illogical.
It would be as yet premature to apply these findings to people with metastases from other cancers, but they should spark further investigations of the value of surgery to remove primary tumours in such patients.
The value of nephrectomy in metastatic renal-cell cancer patients has long been debated; several nonrandomised studies have indicated a higher rate of response to systemic therapy and longer survival in nephrectomy patients.
Robert C Flanigan and colleagues from Loyola University Stritch School of Medicine, Maywood, Illinois, and other major centres across the US, did this current work.
Study participants were 141 patients with metastatic renal-cell cancer who were candidates for nephrectomy.
Researchers randomly assigned 120 of the patients to undergo radical nephrectomy followed by interferon alfa-2b or to receive the interferon therapy alone (121 people).
Primary end point was survival, secondary was a response of the tumour to treatment.
Median survival of the 120 people on surgery plus interferon treatment was 11.1 months. Among the 121 patients on interferon alone, it was 8.1 months.
Difference in median survival between the two groups was independent of performance status, metastatic site and presence or absence of a measurable metastatic lesion.
Thus, nephrectomy followed by interferon therapy results in longer survival among patients with metastatic renal-cell cancer than does interferon therapy alone, these authors
conclude.
N Engl J Med 2001;345:1655-1659. "Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer"
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