Interferon alpha 2b as Medical Selection for Nephrectomy in Patients with Synchronous Metastatic Renal Cell Carcinoma: A Consecutive Study

ObjectiveUp to 25% of the patients with synchronous metastatic renal cell carcinoma (mRCC) treated with nephrectomy and interferon alpha-2b (IFN-α) will progress rapidly at metastatic sites and undergo needless surgery for an asymptomatic primary. We reversed the timing of surgery and immunotherapy and evaluated the role of initial IFN-α as selection for nephrectomy.Patients and methodsSixteen patients with mRCC and the primary in-situ received initial IFN-α for 8 weeks (2 weeks 5 × 3 × 106 IU/wk; 2 weeks 5 × 6 × 106 IU/wk; 2 weeks 5 × 9 × 106 IU/wk and 2 weeks 3 × 9 × 106 IU/wk). Patients with either partial remission (PR) or stable disease (SD) underwent nephrectomy followed by IFN-α maintenance at 3 × 9 × 106 IU/wk. Patients were evaluated with regard to age, sex, metastatic sites, morbidity, response, nephrectomy rate, time to progression and survival.ResultsThirteen patients received 2 months of preoperative IFN-α; 3 stopped during the 2 months period due to progressive disease (PD). Eight patients developed either a PR (n = 3) or SD (n = 5) at metastatic sites and underwent nephrectomy. Survival at 1 year is 50% (4/8 patients). Median progression-free survival was 6 months (3–17 months).Two of the 3 patients with PR developed a CR after 2 months maintenance following surgery. Eight patients with PD did not undergo surgery and had a median survival of 4 months (range 1–8 months).ConclusionsAbsence of progression at metastatic sites following IFN-α with the primary tumor in place may be used as selection for nephrectomy in patients with an intermediate prognosis. Currently, a randomized study is underway to assess the role of initial versus delayed nephrectomy in combination with IFN-α with regard to morbidity and survival.