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Review
. 2019 Sep 27:11:1758835919879026.
doi: 10.1177/1758835919879026. eCollection 2019.

Cytoreductive nephrectomy in the current treatment algorithm

Teele Kuusk  1 , Bernadett Szabados  2 , Wing Kin Liu  3 , Thomas Powles  2 , Axel Bex  4
Affiliations
Review

Cytoreductive nephrectomy in the current treatment algorithm

Teele Kuusk et al. Ther Adv Med Oncol. .

Abstract

The two recent prospective randomized trials CARMENA and SURTIME have changed the therapy paradigm of metastatic renal cell carcinoma. The CARMENA trial was conducted to investigate whether cytoreductive nephrectomy (CN) is required in the targeted therapy area, whereas SURTIME studied whether deferred CN in combination with sunitinib can be used to identify patients with inherent targeted therapy resistance. In the current review, we provide a comprehensive discussion of two randomized studies and the current evidence with up-do-date algorithms for treating primary metastatic clear-cell renal cell carcinoma in the era of targeted therapy and immune-checkpoint inhibition.

Keywords: cytoreductive nephrectomy; immunotherapy; metastatic renal cell carcinoma; renal cell carcinoma; sunitinib; systemic therapy; targeted therapy; tyrosine kinase inhibitors.

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Conflict of interest statement

Conflict of interest statement: Axel Bex took part in advisory boards of Pfizer, Novartis, Ipsen, Eisai and Roche. He is the Principal Investigator of the EORTC SURTIME trial sponsored in part by a grant from Pfizer to the EORTC. Thomas Powles received honoraria from Bristol-Myers Squibb, MERCK, and Roche/Genentech; has consulting or advisory roles at AstraZeneca, Bristol-Myers Squibb, Genentech/Roche, Merck, and Novartis; received research funding from AstraZeneca/MedImmune and Roche/Genentech; and has other relationships with Bristol-Myers Squibb and Ipsen.

Figures

Figure 1.
Figure 1.
Decision algorithm for patients with primary mRCC of clear-cell subtype and good performance status. AXI, axitinib; CN, cytoreductive nephrectomy; IMDC, International Metastatic Database Consortium risk model; IPI, ipilimumab; MET, metastases; mRCC, metastatic renal cell carcinoma; MTD, multidisciplinary team decision; NIVO, nivolumab; PD, progressive disease; PEMBRO, pembrolizumab; RCC, renal cell carcinoma.
See this image and copyright information in PMC

References

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