Cytoreductive nephrectomy for metastatic RCC in the era of targeted therapy

Abstract

Metastatic renal cell carcinoma (RCC) has traditionally been associated with a poor prognosis with few effective treatments. In the multimodal treatment of metastatic RCC, cytoreductive nephrectomy (CN) became the standard of care after two randomized trials demonstrated a benefit in overall survival in patients who received CN prior to treatment with interferon. More recently, several agents (sunitinib, sorafenib, temsirolimus, everolimus and bevacizumab) have been developed that target angiogenesis and the cellular growth pathways involved in metastatic RCC. These targeted agents have demonstrated improved outcomes compared to cytokine therapy, and have transformed metastatic RCC treatment. Targeted agents are being used as a first-line systemic treatment in patients with metastatic RCC with unprecedented success, and many studies are now focusing on the role of CN in combination with these agents for patients with metastatic RCC.

Expression of the glucocorticoid receptor in renal cell neoplasms: an immunohistochemical and quantitative reverse transcriptase polymerase chain reaction study

“…Immunotherapy, such as interferon-α and high-dose interleukin (IL)-2, results in only limited response rates of 15% to 20% [5,6]. Recent advances in targeted molecular therapies with angiogenesis inhibitors, tyrosine kinase inhibitors, and combination treatment modalities have demonstrated improved outcomes; however, the response rates for these novel therapies still remain low [7].…”

Performing Cytoreductive Nephrectomy following Targeted Sunitinib Therapy for Metastatic Renal Cell Carcinoma: A Surgical Perspective

“…A combined analysis of these SWOG and EORTC trials confirmed a longer median survival in the nephrectomy/IFN-α group [8]. In theory, tumour bulk may act as a sink absorbing antibodies and anticancer cells [9] and/or tumour releasing pro-angiogenic factors (VEGF and PDGF) [10]. The role of nephrectomy in the management of mRCC is less well established in the era of targeted therapies.…”

Radio Frequency Ablation of Renal Tumors in Patients With Metastatic Renal Cell Carcinoma

“…16, 17 Although cytoreductive nephrectomy followed by systemic therapy is the current standard of care in the treatment of metastatic RCC, 3–5 critics of that approach argue that surgery could introduce unnecessary morbidity and mortality in this patient population and that it could potentially delay or even prevent these patients from receiving systemic therapy. 18 …”