Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy?

Culp, Stephen H.; Tannir, Nizar M.; Abel, E. Jason; Margulis, Vitaly; Tamboli, Pheroze; Matin, Surena F.; Wood, Christopher G.

doi:10.1002/cncr.25046

Cited by 195 publications

(129 citation statements)

References 48 publications

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“…Patients most likely to benefit from cytoreductive nephrectomy before systemic therapy are those with lung-only metastases, good prognostic features, and good performance status. 37 Although similar data are not available for patients who are candidates for highdose IL-2 (see later discussion), data from the UCLA renal cancer database and from a variety of publications by other groups suggest that nephrectomy also provides benefit to patients who undergo other forms of immunotherapy. 38 As for the role of nephrectomy for patients presenting with metastatic disease and considered for targeted therapies (detailed later), randomized trials are ongoing.…”

Section: Primary Treatment Of Advanced or Stage IV Diseasementioning

confidence: 99%

Kidney Cancer

Motzer¹,

Agarwal²,

Beard³

et al. 2011

J Natl Compr Canc Netw

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An estimated 58,240 Americans were diagnosed with renal cancer and 13,040 died of the disease in the United States in 2010.1 Renal cell carcinoma (RCC) constitutes 2% to 3% of all malignancies, with a median age at diagnosis of 65 years. The rate of RCC has increased by 2% per year for the past 65 years. The reason for this increase is unknown. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors.2 Other less common cell types include papillary, chromophobe, and Bellini duct (collecting duct) tumors. Collecting duct carcinoma constitutes fewer than 1% of kidney cancer cases. Medullary renal carcinoma is a variant of collecting duct renal carcinoma and was described initially as occurring in patients who are sickle cell trait-positive.

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Section: Primary Treatment Of Advanced or Stage IV Diseasementioning

confidence: 99%

Kidney Cancer

Motzer¹,

Agarwal²,

Beard³

et al. 2011

J Natl Compr Canc Netw

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“…These parameters should be taken into consideration before embarking on CRN [30]. A study conducted by the MD Anderson group has also examined who will benefit from CRN and concluded that survival differences between CRN and non-CRN patients did not begin to diverge until 8.5 months [31]. There are statistical models available in predicting the OS in patients with mRCC treated with TT, and maybe, one can make use of these models while selecting patients for CRN [32].…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Khochikar

2016

Indian J Surg Oncol

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Renal cell carcinoma accounts for 3% of adult solid malignant tumours. Approximately 25% of the patients present with metastatic disease at presentation. In the era of immunotherapy (interferon alpha-2b and interleukin-2), studies showed significant survival benefit with cytoreductive nephrectomy (CRN) followed by interferon alpha-2b than interferon alpha 2-b alone. Introduction of targeted therapies (vascular endothelial growth factor receptor-tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors) in 2005 generated a great interest in the management of metastatic renal cell carcinoma (mRCC) as these drugs exhibited tumour shrinkage in the primary tumour as well as in the metastatic site/s. Though there is no level 1 evidence, many studies have shown the usefulness of cytoreductive nephrectomy along with targeted therapy as against to targeted therapy alone. This review is aimed at the rationale behind the cytoreductive nephrectomy in mRCC, the current evidence and what is in store for the future. A detailed search on the management of mRCC was carried out on MEDLINE, Embase, CANCERLIT and Cochrane Library databases using the key words Bcytoreductive nephrectomy^, Bimmunotherapy^and Btargeted therapy^since 1980 till 2015. Original articles, review articles, monograms, book chapters on metastatic renal cancer and textbooks on urologic oncology, oncology and urology were reviewed. Various international guidelines on this issue were also studied. An identical search was performed using the American Society of Clinical Oncology Abstract database. Trials in the progress or recently completed that were relevant to this paper were identified through clinicaltrials.gov. The latest information for new articles ahead of publication was last accessed in November 2015. CRN has remained an integral part to the management of metastatic renal cell carcinoma mainly for the patients with good performance status, life expectancy of more than 12 months and in the absence of adverse prognostic factors. It had shown measurable survival benefit in the era of immunotherapy (CRN + immunotherapy vs. immunotherapy alone). In the era of targeted therapy, many studies have shown significant survival benefit with CRN + targeted therapy. However, there is no clear level 1 evidence to support this. The ongoing trials (CARMENA and European Organisation for Research and Treatment of Cancer SURTIME) would perhaps guide us in the way in which we should manage mRCC disease in the future. Maybe we may find some answers on the issues of the effectiveness of targeted therapy, the timing of CRN and sequencing these treatment arms once the results of these ongoing and future trials are through.

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“…Appropriately selected patients for CN include: patients with a primary tumour amenable to surgical extirpation, a low risk of perioperative morbidity, good performance status (Eastern Cooperative Oncology Group [ECOG] 0 or 1), no evidence of active brain metastases, and a low number of MD Anderson risk factors (elevated lactate dehydrogenase [LDH], low albumin, symptomatic metastases, sites of disease, and clinical ≥T3 primary tumour), and less than four IMDC adverse risk features. 73,80 Moreover, there should be a low risk of rapid disease progression that would not be compatible with the delay of systemic therapy required for recovery from surgery (e.g., no high-grade or sarcomatoid features). 81 In patients who do not undergo upfront CN, but have a good response to VEGFr TKI or targeted therapy, limited metastatic disease, and good performance status, it is reasonable that CN be considered during the course of their treatment.…”

Section: Reaume Et Al Bocytosis)mentioning

confidence: 99%