Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Genitourinary tumours, non-prostate

3772 - Immediate versus deferred cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mRCC) receiving sunitinib (EORTC 30073 SURTIME).


09 Sep 2017


Genitourinary tumours, non-prostate


Cytotoxic Therapy;  Surgical Oncology;  Radiation Oncology;  Renal Cell Cancer


Axel Bex


Annals of Oncology (2017) 28 (suppl_5): v605-v649. 10.1093/annonc/mdx440


A. Bex1, P. Mulders2, M.A.S. Jewett3, J. Wagstaff4, R. van Velthoven5, P.M. Laguna Pes6, L. Wood7, H.H.E. van Melick8, P. Soetekouw9, J.B. Lattouf10, T. Powles11, E. Boleti12, I. de Jong13, S. Rottey14, B. Tombal15, S. Marreaud16, L. Collette16, S. Collette16, C.U. Blank17, J.B. Haanen18

Author affiliations

  • 1 Surgical Oncology-urology, The Netherlands Cancer Institute, 1066CX - Amsterdam/NL
  • 2 Urology, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 3 Department Of Surgery, Princess Margaret Cancer Center, Toronto/CA
  • 4 Oncology, South West Wales Cancer Institute Singleton Hospital, Sketty, SA2 8QA - Swansea/GB
  • 5 Urology, Hopital Jules Bordet, 1000 - Brussels/BE
  • 6 Urology, Amsterdam Medical Center, 1105AZ - Amsterdam/NL
  • 7 Division Of Medical Oncology, Queen Elizabeth II Health Sciences Centre, B3H2Y9 - Halifax/CA
  • 8 Urology, Antonius Hospital, 3435CM - Nieuwegein/NL
  • 9 Oncology, Academisch Ziekenhuis Maastricht (AZM), 6229 HX - Maastricht/NL
  • 10 Oncology, Cliniques Universitaires St. Luc, 1200 - Brussels/BE
  • 11 Oncology, St. Bartholomew's Hospital, EC1A 7BE - London/GB
  • 12 Medical Oncology, Royal Free Hospital School of Medicine, NW3 2QG - London/GB
  • 13 Urology, UMC Groningen, 9713GZ - Groningen/NL
  • 14 Oncology, Belgium Society of Medical Oncology, 1090 - Brussels/BE
  • 15 Urology, Cliniques Universitaires St. Luc, 1200 - Brussels/BE
  • 16 Statistics, EORTC - European Organisation for Research and Treatment of Cancer, 1200 - Brussels/BE
  • 17 Medical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 18 Department Of Medical Oncology, The Netherlands Cancer Institute, 1066 CX - Amsterdam/NL


Login to access the resources on OncologyPRO.

If you do not have an ESMO account, please create one for free.

Abstract 3772


In clinical practice, mRCC patients with the primary tumour in situ are offered CN followed by targeted therapy. This randomized trial explored a period of targeted therapy (sunitinib) prior to CN as an alternative approach.


Patients with mRCC were randomized 1:1 to immediate CN followed by sunitinib versus 3 cycles sunitinib followed by CN and sunitinib. Inclusion required histologically confirmed clear-cell subtype, resectable asymptomatic primary tumour and 


The study closed after 5.7 years with 99 patients entered by 19 institutions. As of May 5, 2017, median follow-up is 3.3 years. In the immediate CN arm, 46 of 50 patients had CN, 40 of 46 had post-CN sunitinib. In the deferred CN arm, 48 of 49 patients had sunitinib, 40 of 48 had CN and 26 of 40 had post-CN sunitinib (Table). PFR was 42.0% (CI: 28.2 – 56.8) and 42.9% (28.8 – 57.8) in the immediate and deferred arms, resp (p > 0.99). The OS HR (stratified by WHO PS) of intention to treat (ITT) with deferred versus immediate CN in all patients was 0.57 (CI: 0.34 – 0.95, p = 0.032) with a median OS of 32.4 (14.5-65.3) and 15.1 months (CI: 9.3, 29.5), respectively.



Immediate CN N = 50Deferred CN N = 49
Median age (years)60.058.0
WHO PS 0:/1:72.0%/28.0%63.3%/36.7%
MSKCC intermediate risk86.0%87.7%
≥ 2 measurable metastatic sites86.0%93.9%
Mean (SD) primary tumor size (mm)93.1 (37.8)96.8 (31.3)
Progression at week 16* (*before planned CN in the deferred arm)46%32.7%*
CN performedN = 46N = 40
Surgical complications43.5%27.5%
Progression 4 weeks after CN19.6%23.5%


The sequence of CN and sunitinib did not affect the PFR at 28 weeks. The sample size precludes definitive conclusions from other endpoints, although an OS signal was seen for deferred CN. CN after sunitinib appears safe.

Clinical trial identification


Legal entity responsible for the study





A. Bex: Participation in Advisory boards of Pfizer, BMS, Roche, Eisai and Ipsen. M.A.S. Jewett: Honorarium: Ipsen, Pfizer. Consultant: Pfizer, Theralase Therapeutics Inc. Ownership: Stock Theralase Therapeutics Inc. J. Wagstaff: Advisory boards for Pfizer. T. Powles: Research funds: Pfizer, Novartis, Roche, AZ. Honoraria: Pfizer, Novartis, Roche, BMS, MSD, Ipsen, Eisei.E. Boleti: Advisory board for Pfizer, Eisai, Ipsen. S. Rottey: Speaker fee from BMS, Pfizer, Roche, Bayer. C.U. Blank: Advisory board for Pfizer, BMS and Roche. J.B. Haanen: Advisory role for Pfizer. All other authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings
  • Necessary cookies enable core functionality. The website cannot function properly without these cookies, and you can only disable them by changing your browser preferences.