Considerations for the Next Clinical Trial Evaluating the Role of Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma

Eur Urol Focus. 2019 Nov;5(6):927-929. doi: 10.1016/j.euf.2019.05.006. Epub 2019 May 16.

Abstract

Trials SWOG 8949 and EORTC 30947 had the same eligibility criteria and established the role of cytoreductive nephrectomy for metastatic renal cell carcinoma. The more recently published CARMENA trial calls into question the need for cytoreductive nephrectomy. A systematic comparison of CARMENA and SWOG 8949 suggests that cytoreductive nephrectomy may be beneficial for patients receiving immunotherapy but not targeted therapy. The approval of immune checkpoint inhibitors for previously untreated metastatic renal cell carcinoma underlines the need for another randomized phase 3 trial of cytoreductive nephrectomy for patients receiving powerful modern immunotherapies.

Keywords: cytoreductive nephrectomy; immunotherapy; metastatic renal cell carcinoma.

Publication types

  • Comparative Study

MeSH terms

  • Antineoplastic Agents, Immunological / therapeutic use
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Renal Cell / surgery*
  • Clinical Trials, Phase III as Topic
  • Cytoreduction Surgical Procedures / methods*
  • Humans
  • Immunotherapy / methods
  • Ipilimumab / therapeutic use
  • Kidney Neoplasms / secondary*
  • Nephrectomy / methods*
  • Nephrectomy / trends
  • Nivolumab / therapeutic use
  • Protein Kinase Inhibitors / therapeutic use
  • Randomized Controlled Trials as Topic
  • Sunitinib / therapeutic use
  • Survival Analysis

Substances

  • Antineoplastic Agents, Immunological
  • Ipilimumab
  • Protein Kinase Inhibitors
  • Nivolumab
  • Sunitinib