Cytoreductive nephrectomy: A medical oncologist’s perspective

Highlights

• The role of cytoreductive nephrectomy was well established in the cytokine era.

• The preponderance of evidence based on retrospective datasets and population-based registries supports use of the procedure in the targeted therapy era.

• Two prospective studies evaluating cytoreductive nephrectomy in the context of sunitinib are appropriately designed, but results may mature at a time when the nature of systemic therapy for mRCC is once again changing.

Abstract

The role of cytoreductive nephrectomy (CN) was firmly established in the cytokine era on the basis of 2 randomized studies employing adjunctive interferon therapy. However, systemic therapy for metastatic renal cell carcinoma has evolved markedly over the past decade, with targeted therapies representing the standard of care in the front-line setting. The preponderance of retrospective data generated to date appears to suggest that the benefit of CN is maintained in the targeted therapy era. However, these studies are inherently prone to selection bias and cannot substitute prospective evidence. Herein, we discuss ongoing prospective studies evaluating CN and propose novel strategies to evaluate this surgical technique in the context of an evolving therapeutic landscape.