Dr. Thiel on Overall Survival Data From the CARMENA Trial in mRCC

David D. Thiel, MD, chair, Department of Urology, Mayo Clinic, discusses the phase III randomized CARMENA trial, which examined cytoreductive nephrectomy plus sunitinib (Sutent) versus sunitinib alone in patients with metastatic renal cell carcinoma (mRCC).

The CARMENA trial questioned cytoreductive nephrectomy in all patients with mRCC and compared the efficacy of frontline cytoreductive nephrectomy followed by sunitinib versus sunitinib alone. Thiel explains that due to difficulty with accruing patients, the CARMENA trial had many intermediate- and poor-risk patients with mRCC. He adds that physicians should be more selective in choosing patients to receive cytoreductive nephrectomy. The current standard of care, according to Thiel, is to remove the kidney of every patient with mRCC who can tolerate it. Thiel explains the surgical morbidity is high in patients with mRCC. Additionally, certain patients do not benefit from having their kidney removed; rather, it is more beneficial for them to receive systemic therapy.

The trial showed patients who got upfront sunitinib followed by nephrectomy had better overall survival (OS) than patients who got cytoreductive nephrectomy followed by sunitinib. An updated analysis of the intent-to-treat population showed that the OS was 15.6 months in cytoreductive nephrectomy plus sunitinib and 19.8 months in sunitinib alone.