VIDEO: Cyto-KIK trial examines cabozantinib and cytoreductive nephrectomy

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There's a multicentered trial called Cyto-KIK, which is looking at patients with metastatic renal cell carcinoma, who are going to be treated upfront with combination cabozantinib and immunotherapy. Then after three months of therapy, they're going to be offered cytoreductive nephrectomy, and then subsequent to that they're going to resume combination therapy. And the clinical trial itself is looking to see if patients will have a complete response to combination therapy. And they're going look at the patients who basically are combination therapy resistant to see if there's any pathologic features or clinical features that will predict, who's going to respond to therapy or not.

But on this abstract, they asked a much more straightforward question. They wanted to know whether the cytoreductive nephrectomy should be offered two weeks or three weeks after stopping therapy. And that's a difficult question for all surgeons because there are scenarios where patients are getting systemic therapy. The medical oncologist ask us to proceed with a consolidative cytoreductive nephrectomy, or perhaps the patient's symptomatic, and we have to proceed to nephrectomy. And we know from experience how long to wait in patients who had chemotherapy. But with these multi kinase inhibitors, we know their half-life, but we don't know how long clinically they might put patients in a situation where should they should not be operated on.

And this abstract out of Ohio State University, Rutgers-Cleveland Clinic and Columbia lead author being Dr. Kerry Rancy, looked at patients who were treated with three months of combination immunotherapy and cabozantinib. And then they were taken to the operating room after two weeks to three weeks to see if there was any difference in terms of complications. And mind you, they only had eight patients, five in one group, three in the other group. But they noticed that there was no difference in overall complications in these two groups. And in fact, there were no significant complications.

Mind you, the groups did not have any bone mets. They're still occurring for this study. I think the study itself is going to be interesting in terms of asking what role cytoreductive nephrectomy will play in the adjuvant setting. But for us as surgeons, it's useful to know that basically after stopping cabozantinib for two weeks, patients can be taken to the RP group. The immunotherapy was not as relevant because immunotherapy was given on a monthly basis, so you had at least anywhere from two to four week lag between immunotherapy and taking patients to surgery.