Dr. Drake Discusses the CARMENA Trial in Metastatic RCC

Charles G. Drake, MD, PhD, director of Genitourinary Oncology, NewYork-Presbyterian/Columbia University Medical Center and co-director of Columbia’s Cancer Immunotherapy Programs, discusses the CARMENA trial in metastatic renal cell carcinoma (mRCC).

The phase III noninferiority trial CARMENA compared cytoreductive nephrectomy followed by sunitinib (Sutent) versus sunitinib alone in patients with intermediate- and high-risk mRCC. Cytoreductive nephrectomy is the current standard of care for this population. Drake says that up until this trial, removing the primary lesion from the kidney has not been proven to increase length or quality of life. Most of the retrospective studies that have been done are subject to bias, he adds, as surgeons are able to pick which patient they believe will respond best.

Results showed that patients who had their primary kidney lesion taken out did not necessarily live longer, which Drake says was surprising. The 2 approaches were statistically equivalent in terms of overall survival (OS), proving sunitinib noninferior. The median OS was 18.4 months for sunitinib compared with 13.9 months for standard of care (HR, 0.89; 95% CI, 0.71-1.10). Additionally, the median progression-free survival was 7.2 months (95% CI, 6.2-8.5) with sunitinib alone versus 8.3 months (95% CI, 6.2-9.9) with surgery plus sunitinib.