Cytoreductive nephrectomy in the current treatment algorithm

Teele Kuusk; Bernadett Szabados; Wing Kin Liu; Thomas Powles; Axel Bex

doi:10.1177/1758835919879026

Cytoreductive nephrectomy in the current treatment algorithm

Ther Adv Med Oncol. 2019 Sep 27:11:1758835919879026. doi: 10.1177/1758835919879026. eCollection 2019.

Authors

Teele Kuusk¹, Bernadett Szabados², Wing Kin Liu³, Thomas Powles², Axel Bex⁴

Affiliations

¹ Royal Free Hospital, Department of Urology, Renal Cancer Unit, London, UK.
² Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London, UK.
³ Royal Free Hospital, Department of Medical Oncology, London, UK.
⁴ Royal Free Hospital, Department of Urology, Renal Cancer Unit, University College London, Division of Surgical and Interventional Sciences, London, UK.

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.

Publication types

Review