Initial and Repeat Metastasis-Directed Therapy in Systemic Therapy-Naïve Oligometastatic Renal Cell Carcinoma:...

Area of Science:

• Oncology
• Urologic Oncology
• Renal Cell Carcinoma Research

Background:

• Metastasis-directed therapy (MDT) shows promise for delaying systemic treatment in oligometastatic renal cell carcinoma (OM-RCC).
• Real-world outcomes of MDT, especially repeat treatments in treatment-naïve patients, require further characterization.

Purpose of the Study:

• To evaluate the effectiveness of MDT in systemic therapy-naïve OM-RCC patients.
• To assess outcomes of repeat MDT in patients experiencing relapse without prior systemic therapy.
• To identify predictors of progression and survival following MDT.

Main Methods:

• Retrospective analysis of 133 systemic therapy-naïve OM-RCC patients treated with MDT (metastasectomy, SBRT, RFA).
• Analysis included 38 patients who received a second MDT for subsequent relapse without systemic therapy.
• Kaplan-Meier, Cox regression, and time-varying Cox models assessed PFS, STFS, and OS. A risk score was developed using DFI (<1 year) and metastatic burden (≥2 lesions).

Main Results:

• Five-year systemic therapy-free survival (STFS) and overall survival (OS) were 44.9% and 85.0%, respectively.
• Two-year progression-free survival (PFS) was similar after the first (47.9%) and second MDT (39.9%).
• A risk score combining DFI < 1 year and ≥2 lesions effectively stratified outcomes after MDT.

Conclusions:

• MDT provides durable disease control and delays systemic therapy in OM-RCC.
• Repeat MDT can achieve comparable progression control to initial treatment in selected patients.
• A simple risk score aids in patient selection and shared decision-making for MDT.