Cytoreductive nephrectomy and its role in the present-day period of targeted therapy

Abstract

Abstract:The beneficial effect of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma in the immunotherapy era was based on two prospective randomized trials. Unfortunately, such evidence does not yet exist in the present-day period of targeted therapy. Despite this, cytoreductive nephrectomy remains integral in the multimodal management of patients with metastatic renal cell carcinoma. Multiple retrospective studies as well as data from prospective studies examining targeted therapy support the continued use of cytoreductive nephrectomy in the properly selected patient. Ongoing studies will hopefully fine-tune the role and timing of cytoreductive nephrectomy in the context of targeted therapy.

Real-World Survival Outcomes and Prognostic Factors Among Patients Receiving First Targeted Therapy for Advanced Renal Cell Carcinoma: A SEER–Medicare Database Analysis

“…Real-world Outcomes in Advanced Renal Cell Carcinoma e578 -Clinical Genitourinary Cancer August 2017 sunitinib 52 and might contribute important evidence regarding whether this therapeutic approach can further improve OS among patients with RCC.…”

Role of cytoreductive nephrectomy in the targeted therapy era: A systematic review and meta-analysis

“…Furthermore, they identified nine variables that were associated with overall mortality and that could be assessed preoperatively: presentation (incidental or local systemic symptoms), KPS, hemoglobin, neutrophils, platelets (normal or greater), corrected calcium, albumin, clinical N stage, and number of metastatic sites. Culp [ 7 ] identified seven variables to distinguish between patients who benefit from this therapy and noted that with at least four criteria, there are no differences: serum albumin, LDH, T3 or T4, hepatic metastasis, metastatic-associated symptoms, and retroperitoneal and supradiaphragmatic lymph nodes. Perhaps, the question could be: When is the correct time to perform CRN in these patients?…”

“…In the early 2000s, two clinical trials showed better survival rates when cytoreductive nephrectomy (CRN) was performed prior to interferon α-2b (IFN-α) therapy compared to IFN-α therapy alone [ 5 6 ]. However, since 2005 multiple drugs have been developed and approved as the result of an improved understanding of the molecular mechanisms underlying the development and progression of RCC [ 7 ]. The mechanism of action of these drugs—tyrosine kinase inhibitors of vascular endothelial growth factor receptor—has led to their use being called targeted therapy (TT).…”

Comprehensive characterization of the perioperative morbidity of cytoreductive nephrectomy

“…There are currently two ongoing randomized trials examining CN with targeted therapies, CARMENA (NCT0093033) and SURTIME [NCT01099423 ( 5 )]. Unfortunately, CARMENA, which randomized patients to CN + sunitinib vs. sunitinib alone will not be completed until 2018 and is limited by non-inferiority design and patient accrual issues.…”