The value of cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy.
You D, Jeong IG, Ahn JH et al.
The role of cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) was largely defined by the European Organisation for Research and Treatment of Cancer and Southwest Oncology Group trials, which showed improved survival in patients treated with CN followed by immunotherapy compared with immunotherapy alone. The recent introduction of small-molecule inhibitors such as tyrosine kinase and mammalian target of rapamycin inhibitors, supported by evidence demonstrating an additional survival benefit compared with CN and immunotherapy, has meant that these drugs are currently the treatment of choice for mRCC. The evolution and success of such targeted therapy has posed a few questions concerning the current role of CN in mRCC. Firstly, as current targeted therapy has been shown to induce a greater response in the primary tumor than immunotherapy, does this response neutralize the benefit of CN? Secondly, can we justify the time delay before medical therapy resulting from CN given the survival data in patients managed with medical therapy alone?