Outcomes of treatment, laboratory results, adverse effects, and tolerability of cancer treatment in patients with metastatic renal cell carcinoma treated with cabozantinib after cytoreductive nephrectomy

Introduction. This publication aims to present the results of a retrospective analysis of the treatment outcomes of patients with metastatic renal cell carcinoma (mRCC) treated with cabozantinib who underwent cytoreductive nephrectomy (CN), radical nephrectomy (RN) or nephron-sparing surgery (NSS) and in whom surgery was omitted. Material and methods. The retrospective analysis includes the outcomes of 35 patients treated and followed at the Institute of Oncology, Poznan University of Medical Sciences, between May 2022 and July 2024. Results. A detailed analysis was conducted to assess the impact of prior CN on the efficacy of cabozantinib treatment. Treatment outcomes were compared between two groups of patients — those who underwent CN (study group, n = 8) and those with no prior surgical treatment (control group, n = 12). No effect of CN was found on tumor progression in patients treated with cabozantinib (p = 0.6479). A statistically significant difference in PFS (progression-free survival) duration was observed between the two groups, favoring patients who had undergone CN before starting cabozantinib therapy (p = 0.0337). The duration of treatment and the number of cabozantinib cycles received in both groups were also compared. There was no statistically significant difference in the duration of cabozantinib treatment (p = 0.3744) and in the number of cabozantinib treatment cycles (p = 0.3731) in the compared groups. The frequency and severity of adverse events of cabozantinib treatment in patients who underwent CN compared to patients who did not undergo surgical treatment were also analyzed. There was no statistically significant correlation between undergoing CN and the occurrence of adverse events, the need for dose reduction, or the extension of the intervals between cabozantinib cycles during treatment (p = 0.6186). Conclusions. The results of the present study confirm the important role of CN in the treatment of patients with mRCC receiving cabozantinib. Further studies on predictive biomarkers are needed to improve patient stratification and identify those most likely to benefit from cabozantinib therapy, as well as those who may benefit most from CN. The decision to perform CN should always be made by a multidisciplinary oncology team including a urologist, oncologist, and radiation therapist. Appropriate selection of patients eligible for CN is crucial to achieving optimal cancer treatment outcomes. Qualification for CN should be individualized and based on a thorough analysis of the potential benefits and risks of the procedure. Due to the lack of direct data on the role of CN in the treatment of patients with mRCC receiving cabozantinib, further prospective, randomized trials are needed to determine the optimal treatment strategy for this patient population.