Comparison of Immediate vs Deferred Cytoreductive Nephrectomy in Patients With Synchronous Metastatic Renal Cell Carcinoma Receiving Sunitinib

This was a randomised phase II trial of immediate versus deferred nephrectomy in patients who were diagnosed with metastatic renal cancer with the primary cancer still in situ. Patients were randomised to have and up-front nephrectomy followed by sunitinib or three cycles of sunitinib followed by nephrectomy. Patients continued sunitinib after nephrectomy. Deferred nephrectomy did not improve the 28 week progression free rate. However the median survival of the patients in the deferred nephrectomy arm was 32.4 months in the deferred nephrectomy arm and 15 months in the immediate nephrectomy arm. These data suggest that sunitinib followed by deferred nephrectomy may identify a group of patients with inherent resistance to systemic therapy and who do not benefit from immediate nephrectomy