Cytoreductive Nephrectomy in Metastatic Patients with Signs or Symptoms: Implications for Renal Cell Carcinoma Guidelines

Larcher, Alessandro; Fallara, Giuseppe; Rosiello, Giuseppe; Re, Chiara; Baiamonte, Gianfranco; Agnesi, Stefano; Cignoli, Daniele; Colandrea, Gianmarco; Basile, Giuseppe; Briganti, Alberto; Salonia, Andrea; Bertini, Roberto; Montorsi, Francesco; Capitanio, Umberto

doi:10.1016/j.eururo.2020.05.014

Cited by 28 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to conclusions from the CARMENA and SURTIME studies, upfront CN should not be considered superior to medical therapy alone, at least for patients with intermediate-or poor-risk disease who require systemic treatment. Moreover, for symptomatic patients (eg, in the presence of severe hematuria or intractable pain), CN still has a role for symptom palliation [5].…”

Section: Clinical Case Discussionmentioning

confidence: 99%

Treatment Options for De Novo Metastatic Clear-cell Renal Cell Carcinoma: Current Recommendations and Future Insights

Benamran

Albigès

Bex

et al. 2022

European Urology Oncology

Self Cite

View full text Add to dashboard Cite

This clinical case-based discussion focuses on a 73-yr-old man diagnosed with intermediate-risk oligometastatic clear-cell renal cell carcinoma (RCC) and treated with systemic therapy. Current guideline-based treatment options are presented and critically examined. The discussion covers the main aspects of the management of metastatic RCC, such as the role of cytoreductive nephrectomy and metastasisdirected therapies, as well as the multiple options for systemic targeted and immune therapies. An insight into developments that may play a role in treatment pathways in the future according to the latest scientific advances is also provided. Patient summary: A number of treatment options are available for patients who have metastatic disease when diagnosed with clear-cell kidney cancer. Starting from a clinical case, the current standard of care and future perspectives regarding treatment of this disease are presented.

show abstract

Section: Clinical Case Discussionmentioning

confidence: 99%

Treatment Options for De Novo Metastatic Clear-cell Renal Cell Carcinoma: Current Recommendations and Future Insights

Benamran

Albigès

Bex

et al. 2022

European Urology Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the current era, indications for cytoreductive nephrectomy either as a first-line or deferred therapy after a period of systemic therapy include (1) IMDC Intermediate-risk patient with no more than one risk factor in whom systemic therapy can be safely delayed; (2) Management of local symptoms (this decisionmaking must be carefully balanced against litmus test of systemic therapy) [20]; (3) Consolidation of the primary tumour treatment in patients with stable, low volume metastases or with complete resolution/significant partial response following the receipt of systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…However, in symptomatic patients with metastatic RCC, is cytoreductive nephrectomy beneficial from a symptom perspective or is it associated with increased risks due to peri-operative morbidity? Larcher et al [20] queried a prospectively maintained database of kidney cancer patients. Overall, the investigators evaluated 317 patients and found that 37% had local symptoms.…”

Section: Timing Of Cytoreductive Nephrectomymentioning

confidence: 99%

The role of cytoreductive nephrectomy in the immuno-oncological therapy era

Magee

Helstrom

Kutikov

2023

Current Opinion in Urology

View full text Add to dashboard Cite

Purpose of review Cytoreductive nephrectomy has had a variable role in the management of metastatic renal cell carcinoma (RCC) through the different systemic therapy eras. Initially felt to be beneficial with interferon, the utility of cytoreductive nephrectomy was called into question in the tyrosine kinase inhibitor (TKI) era. However, with the advent of immunotherapy for metastatic RCC, the role of cytoreductive nephrectomy continues to be debated. This study sought to evaluate the recent literature and discuss cytoreductive nephrectomy within the context of an improved systemic therapy era. Recent findings The literature that exists on the use of cytoreductive nephrectomy with immunotherapy is retrospective in nature and largely derived from large, institutional databases. Although smaller, single-institution articles exist and provide more granular data, issues concerning selection bias and unmeasured confounders persist. Overall, the available studies demonstrate that patient selection is paramount, and cytoreductive nephrectomy should be reserved for patients with no more than one risk factor, those requiring palliation of local symptoms and for those patients with stable, low volume disease or with a complete response following systemic therapy exposure. Summary The optimal use of cytoreductive nephrectomy in metastatic RCC remains unclear, but certain subgroups of patients, on evaluation of post hoc and retrospective data, seem to benefit from surgical intervention.

show abstract

“…Two out of three patients suffer from any sign or symptom, and one out of three suffers from local signs or symptoms. According to these data, CN has a positive impact on symptomatic status [12] .…”

mentioning

confidence: 84%