Role of cytoreductive surgery in the era of immunotherapy

Abstract

Purpose of reviewThe benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI þ TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap. Recent findingsData from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited.

Analysis of the impact of cytoreductive surgery in patients with oligometastatic renal cell carcinoma in clinical practice

“…Роль циторедуктивных операций при современном арсенале системной терапии для пациентов с мПКР четко не определена [7]. При решении вопроса о целесообразности ЦНЭ при мПКР решающую роль играют отбор пациентов, группа прогноза по IMDC, что особенно важно при медленно растущих метастазах, когда можно длительно наблюдать пациента до прогрессирования [4].…”

Robot-assisted radical nephrectomy with inferior vena cava thrombectomy: a case report

“…Pignot et al concluded that delayed CN in patients who responded to ICI treatment provided promising oncological outcomes, and most patients could discontinue systemic treatment ( 20 ). However, from a surgical perspective, ICI-based combination therapy results in a severe desmoplastic reaction, which increases perinephric adhesions and inflammation, thus increasing surgical complexity ( 21 ). Accordingly, ongoing prospective studies, such as PROBE and NORDIC-SUN, will better define the role of CN in the rapidly evolving treatment landscape of mRCC in combination with ICI-based systemic therapy.…”