Regarding the impact of surgery we need to determine if treating patients with drugs prior to complete surgical resection would work even better. Would giving a limited period of drug treatment after complete surgical resection make things better? Our data so far would indicate that it is not the case. We’ve been doing genetic analyses on these patients looking at the genetics of the primary tumor, and the metastatic disease to determine if we can better predict which patients will do well with these treatments, and which drugs to give if and when they do have recurrent disease after resection.
The challenges and need for additional work is seemingly endless.
Are there currently any ongoing trials looking at those challenges?
We have an ongoing trial of complete surgical resection with drug treatment afterwards. There are multiple trials of new drug therapies. We have a program now where we take out the metastatic disease and grow it in an animal model and test various drugs to determine the best form of treatment for the patient.
Is there anything else you would like to highlight?
I think the take-home message is, despite the fact that we have many new drugs for treating kidney cancer, they are unfortunately rarely curative. The data seem to indicate that surgical removal of disease remains an integral portion of providing those patients with maximum extension of life. We don’t want people to forget about the potential positive impact of surgery and the overall improvements that we’re making in the care of these patients.
Zaid HB, Parker WP, Safdar NS, et al. Outcomes following complete surgical metastasectomy for patients with metastatic renal cell carcinoma: a systematic review and meta-analysis. J Urol. 2017; 197(1):44-49. doi: 10.1016/j.juro.2016.07.079