Cytoreductive Nephrectomy in 2021: Obsolete

Discovery of a novel monoclonal PD-L1 antibody H1A that promotes T-cell mediated tumor killing activity in renal cell carcinoma

“…Survival benefit of upfront cytoreductive nephrectomy prior to treatment with immune checkpoint blockade has only been reported in retrospective studies [28]. As the therapeutic landscape of metastatic RCC rapidly evolves, the role of cytoreductive nephrectomy in the immunotherapy era is currently evaluated in randomized clinical trials (PROBE, NORDIC-SUN trials) [29]. Here, we…”

Effect of Inferior Vena Cava Tumor Thrombus on Overall Survival in Metastatic Renal Cell Carcinoma Patients Treated with Cytoreductive Nephrectomy

“…Second, selection biases are clearly applicable and cannot be controlled for, like in previous analyses by Abel et al [2] , as well as Lenis et al [3] . Within the current study design, which exclusively investigated surgically treated patients, age was restricted to ≤75 yr at diagnosis to account for a more pronounced and more heterogeneous perioperative risk profile with increasing age, especially above 75 yr. Third, absence of specific information that would have allowed stratification according to the risk criteria, as well as detailed information regarding systemic therapy, including the sequence of systemic therapy, was not available within the current study population [1] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] . Fourth, pT3a-substage patients with tumor features (eg, perinephritic fat invasion) other than vascular invasion were excluded from the initial analyses and were subsequently considered in a secondary analysis without change to the recorded results.…”

Multidisciplinary treatment (MDT) perspectives in renal cell carcinoma

“…There have been several trials using SABR in those with oligoprogressive disease in combination with TKIs which showed median delay of next systemic therapy of up to 11.1 months 18 and 12.6 months. 19,20 Another contentious issue is the role of cytoreductive nephrectomy which was established early on as beneficial in the cytokine era, 21 until more recent studies that brought into question the role of unselected front-line cytoreductive nephrectomy, 22 especially in the targeted therapy era with CARMENA 23 and SURTIME 24 trials showing no improvement in immediate versus deferred nephrectomy compared to upfront systemic therapy approach, with lack of specific guidelines in recommending delayed cytoreductive nephrectomy in patients who might derive benefit from systemic treatment. 25 Historical trials utilizing systemic therapy with VEGF-TKI and interleukin-2 included patients who have underwent prior nephrectomy rates from 67% to 100%.…”