The role of cytoreductive nephrectomy for renal cell carcinoma in the era of targeted therapy

2008 ◽  
Vol 5 (12) ◽  
pp. 698-699 ◽  
Author(s):  
Simon Chowdhury ◽  
Peter G Harper ◽  
Toni K Choueiri
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cytoreductive Nephrectomy

Role of cytoreductive nephrectomy for Japanese patients with primary renal cell carcinoma in the cytokine and targeted therapy era

2015 ◽  
Vol 22 (8) ◽  
pp. 736-740 ◽  
Author(s):  
Katsunori Tatsugami ◽  
Nobuo Shinohara ◽  
Tsunenori Kondo ◽  
Toshinari Yamasaki ◽  
Masatoshi Eto ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Japanese Patients ◽  
Cytoreductive Nephrectomy ◽  
Primary Renal Cell Carcinoma

Surgical Management of Advanced Kidney Cancer: The Role of Cytoreductive Nephrectomy and Lymphadenectomy

2018 ◽  
Vol 36 (36) ◽  
pp. 3601-3607 ◽  
Author(s):  
Hiten D. Patel ◽  
Jose A. Karam ◽  
Mohamad E. Allaf
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Surgical Management ◽  
Kidney Cancer ◽  
Renal Cell ◽  
Locally Advanced ◽  
Cytoreductive Nephrectomy ◽  
Level 1

Despite the evolution of systemic therapy from the immunotherapy to targeted therapy eras, surgical management remains a mainstay of treatment of patients with locally advanced, lymph node–positive, and distant metastatic renal cell carcinoma. Balancing patient and disease characteristics with the potential morbidity of surgery has gained increasing attention to better define the role of cytoreductive nephrectomy and lymphadenectomy. In this review, we critically evaluate the literature for the potential therapeutic role of cytoreductive nephrectomy and lymphadenectomy in advanced kidney cancer, highlighting current evidence, limitations, and best-management practices. Although retrospective data supported a similar survival benefit for cytoreductive nephrectomy in the targeted therapy era as it did for the initial immunotherapy era (1992 to 2006), level 1 evidence from the randomized Clinical Trial to Assess the Importance of Nephrectomy (CARMENA) demonstrated no benefit for intermediate- and poor-risk patients in the setting of sunitinib therapy. Level 1 evidence among a favorable-risk subset is still awaited from the trial Targeted Therapy With or Without Nephrectomy in Metastatic Renal Cell Carcinoma: Liquid Biopsy for Biomarkers Discovery (TARIBO). Another trial, Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer (SURTIME), has compared upfront cytoreductive nephrectomy prior to targeted therapy with the initial initiation of targeted therapy followed by deferred cytoreductive nephrectomy. Lymphadenectomy is yet another controversial but less well-defined management option for patients with kidney cancer. The role of lymphadenectomy has been studied in both the localized and advanced settings over the past few decades, with a strong suggestion of no therapeutic benefit for patients with cT1-2N0M0 and cM1 disease, and with uncertain benefit in patients with high-risk disease (ie, locally advanced or cN1M0), leading to weak statements among clinical guidelines.

Cytoreductive nephrectomy (CN) in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 396-396 ◽  
Author(s):  
Daniel Yick Chin Heng ◽  
Brian I. Rini ◽  
Benoit Beuselinck ◽  
Jae-Lyun Lee ◽  
Jennifer J. Knox ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Proportional Hazards ◽  
Cytoreductive Nephrectomy ◽  
Marginal Benefit ◽  
Proportional Hazards Regression ◽  
Synchronous Metastases

396 Background: The role of cytoreductive nephrectomy is unclear in patients with synchronous metastases from renal cell carcinoma (RCC) in the age of targeted therapy. Methods: Comparisons were made between patients treated with targeted therapy who had a CN versus not and adjusted using proportional hazards regression for known poor prognostic criteria (IMDC criteria Heng et al JCO 2009). Results: 2569/3245 (79%) mRCC patients received a nephrectomy. Patients who had nephrectomy before the diagnosis of metastatic disease were excluded (n=1634). Among the remaining patients, 935 patients had a CN and 676 patients did not have nephrectomy. All patients received targeted therapy with the majority receiving first-line sunitinib 72%, sorafenib 15%, temsirolimus 5%, bevacizumab 3%, pazopanib 3%. Patients who had CN had better IMDC prognostic profiles versus those without (favorable/intermediate/poor in 9%/63%/28% vs 1%/45%/54% p<0.0001). The median overall survival of patients with CN vs without was 20.6 vs 9.5 months (p<0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95%CI 0.52-0.69, p<0.0001). The Table demonstrates the increasing benefit of CN if a given patient has a longer survival time. Conclusions: CN can be beneficial in patients with synchronous metastatic RCC even after adjustment for prognostic factors. Patients who are estimated to survive less than 9-12 months may have a marginal benefit compared to those with longer estimated survival. This may aid in patient selection as we await results from randomized controlled trials. [Table: see text]

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