The Evolving Role of Cytoreductive Nephrectomy in the New Target Therapy Era

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The lack of prospective studies on cytoreductive nephrectomy in metastatic renal cell carcinoma in the post-interferon era has raised questions.
The lack of prospective studies on cytoreductive nephrectomy in metastatic renal cell carcinoma in the post-interferon era has raised questions.

Cytoreductive nephrectomy (CN) is still an integral part of management of patients with metastatic renal cell carcinoma (RCC), according to an article published in Urologic Oncology.1

Study author Jose Karam, MD, FACS, of The University of Texas MD Anderson Cancer Center in Houston, TX contended that the lack of prospective studies on CN in patients with metastatic RCC in the post-interferon era has raised questions about the role of CN in the targeted therapy era. Questions are also being raised about the optimal timing for CN.

“Patients with metastatic RCC and primary renal tumor in place should be evaluated in a multidisciplinary setting with a urologic oncologist and a medical oncologist, and patients should undergo CN if they are appropriate surgical and medical candidates,” said Dr. Karam, who is  assistant professor in the Department of Urology.

He and his colleagues have just published a review article on the history of CN and how best to select patients for this surgery in the new era of targeted therapies.1

The investigators contended that randomized controlled trials demonstrated that CN for metastatic RCC is associated with a survival advantage in the setting of immunotherapy treatments.

They wrote that the best evidence from large, retrospective series showed that CN before targeted therapies appeared to be associated with improved survival.

However, they cautioned that multiple patient and tumor factors had to be taken into account when considering surgical treatments for patients with metastatic RCC.

RELATED: Novel Imaging Techniques May Eliminate Need for Renal Mass Biopsy for Locally-advanced RCC

“This study is a review article on the history of CN, how to select patients for this surgery, and outcomes of patients. The 2 clinical trials that have shown benefit for CN were published in 2001 in the era of interferon therapy.2,3 Currently, we only have retrospective data supporting the use of CN in the era of targeted therapy, with 2 ongoing clinical trials that are studying the role of targeted therapy with sunitinib in this setting (CARMENA4 and SURTIME5 trials),” Karam said.

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