Dr. Uzzo on the Evolving Role of Surgery in Metastatic Kidney Cancer

Robert G. Uzzo, MD, MBA, FACS, chair, Department of Surgical Oncology, G. Willing "Wing" Pepper Chair in Cancer Research, Kidney, Bladder, and Prostate Cancer TRDG member, senior vice president, Physician Services, Fox Chase Cancer Center, and professor of surgery, Temple University Health System, discusses the evolving role of surgery in metastatic kidney cancer.

As a surgeon, Uzzo says that most of his time is spent thinking about the biology of the tumor and if surgery can be used as an intervention to provide therapeutic benefit. Before many systemic therapies were available, surgery was typically the standard of care for patients with kidney cancer, he explains.

New research, such as the phase III CARMENA and SURTIME trials, are exploring whether surgery is beneficial in the upfront setting for patients with metastatic disease or if it may be more effective after systemic therapies are given. After receiving upfront systemic therapy, many patients become good responders with prolonged partial responses, and sometimes complete responses. The question then becomes whether to revisit the surgical option afterward, says Uzzo. Mainly, how can the results of the systemic therapies be consolidated with surgery? Uzzo predicts more research will be exploring this idea further.

Because these patients will require lifelong treatment for their disease, the overall goal is to get them to a place where they can eventually come off of therapy for long periods of time. Although the emerging agents such as HIF inhibitors and other combinations are generating excitement in the space, the role of surgery continues to evolve and play an important role in the care of patients with kidney cancer, he concludes.