Dr. Drake on the Role of Cytoreductive Nephrectomy in RCC

Charles G. Drake, MD, PhD, director of Genitourinary Oncology, NewYork-Presbyterian/Columbia University Medical Center and co-director of Columbia’s Cancer Immunotherapy Programs, discusses the role of cytoreductive nephrectomy in the treatment of patients with renal cell carcinoma (RCC).

Traditionally, cytoreductive nephrectomy was reasonably well-used in patients with RCC. This was based on findings from 2 studies that compared surgery versus interferon versus interferon alone, showing superior outcomes with surgery. These studies were done before tyrosine kinase inhibitors (TKIs) were being used in RCC. Drake says that in the modern era, the superiority of cytoreductive nephrectomy to TKIs came into question, which led to studies such as CARMENA.

Findings from the CARMENA trial in metastatic RCC showed that sunitinib (Sutent) as a single agent was noninferior for median overall survival (OS) compared with sunitinib plus cytoreductive nephrectomy. Median OS for patients who received sunitinib alone was 18.4 months, compared with 13.9 months for the surgery arm (HR, 0.89; 95% CI, 0.71-1.10). Additionally, sunitinib produced similar median OS results for patients with intermediate (23.4 vs 19.0 months; HR, 0.92; 95% CI, 0.68-1.24) and poor prognosis (13.3 vs 10.2 months; HR, 0.85; 95% CI, 0.62-1.17).