Maxwell Sandberg, MD, on systemic therapy for RCC with tumor thrombus

Recent findings from a retrospective study suggest that preoperative systemic therapy may offer an overall survival (OS) and cancer-specific survival (CSS) benefit for patients with metastatic renal cell carcinoma with tumor thrombus (mRCC-TT) prior to cytoreductive radical nephrectomy and tumor thrombectomy (RN-TT). The data were presented at the 2025 Society of Urology Oncology Annual Meeting in Phoenix, Arizona.¹

In an interview with Urology Times®, presenting author Maxwell L. Sandberg, MD, discussed the background and key findings from the study. Sandberg is a PGY-4 urology resident at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

Overall, the investigators assessed outcomes with preoperative systemic therapy for non-mRCC-TT patients, preoperative systemic therapy for mRCC-TT patients before CN-TT, and postoperative systemic therapy after RN-TT. The analysis included patients from North America, Central/South America, Europe, and South Korea using data from the Intercontinental Collaboration on Renal Cell Carcinoma database.

Overall, data showed significant differences in OS and CSS among patients with mRCC-TT who received preoperative systemic therapy prior to CN-TT (n = 84) vs those who did not (n = 33). The median OS was 2 years in the systemic therapy group vs 0.5 years in the non-systemic therapy group (P = .0007). Similarly, the median CSS was 2.3 years vs 0.5 years, respectively (P = .0007).

Among patients with non-mRCC-TT, there were no statistically significant differences in OS or CSS between those who received preoperative systemic therapy vs those who did not. In fact, data showed significantly worse metastasis-free survival among patients with non-mRCC-TT who received preoperative systemic therapy compared with those who did not. There was also no benefit observed with post-operative systemic therapy after RN-TT.

According to Sandberg, a prospective study is needed to validate these findings.

REFERENCE

1. Sandberg M, Russell G, Malikismail J, et al. Impact of systemic therapy for renal cell carcinoma with a tumor thrombus: results from the intercontinental collaboration on renal cell carcinoma database. Presented at: Society of Urologic Oncology Annual Meeting; December 2-5, 2025; Phoenix, Arizona. Abstract 17. https://suo-abstracts.secure-platform.com/a/gallery/rounds/24/details/4300