Presentation Authors: Dena Battle*, Alexandria, VA, Daniel George, Durham, NC, Axel Bex, Amsterdam, Netherlands, Michael Staehler, München, Germany
Introduction: Conducted over eight years, enrolling 450 patients at multiple centers in Europe, the CARMENA (Cancer du Rein Metastatique Nephrectomie et Antiangiongeniques) trial demonstrated that systemic therapy using sunitinib alone is not worse than cytoreductive nephrectomy (CN) plus sunitinib in metastatic RCC in an intention to treat analysis (hazard ratio HR): 0.89, 95% confidence interval (CI), 0.71-1.10). We wanted to assess patient views related to CN following the publication of these results.
Methods: The Kidney Cancer Research Alliance (KCCure) conducted a survey among kidney cancer patients. The short survey was created via SurveyMonkey and was disseminated in various patient communities using social media and was posted to the KCCure website in June 2018 after the presentation of the CARMENA trial. Patients were asked â€œThe CARMENA trial presented recently at ASCO found that for kidney cancer patients diagnosed with metastatic disease, there is no overall survival benefit of having a nephrectomy prior to starting systemic therapy. Knowing that information, would you still want to have a nephrectomy at diagnosis if you were metastatic?â€ Patients were also asked whether they had already had a nephrectomy and their stage at diagnosis, whether they were on systemic therapy, gender and age.
Results: n=210 patients responded with 60.5% being female. Median age 56.5 years (range 26-84). On the question of whether they would want CN. 75.2% of the patients indicated they would still prefer nephrectomy. Of the patients with primary metastatic disease and the tumor in place treated with systemic therapy, 20.1% wanted their kidney tumor to be removed. There was no statistically significant difference between patients who had experience with systemic therapy and those who hadnâ€™t, answers were also consistent regardless of gender and age.
Conclusions: Overall survival should not be overestimated as the most important aim in an end-stage patient population. Patients might think differently about benefits, risks and value of surgical procedures then physicians.