Dr. Vaishampayan on Systemic Therapy Followed by Cytoreductive Nephrectomy in mRCC

Ulka Vaishampayan, MD, professor of oncology at Wayne State University, and chief of the Solid Tumor Program at Barbara Ann Karmanos Cancer Institute, discusses the considerations when giving patients with metastatic renal cell carcinoma (RCC) systemic therapy followed by cytoreductive nephrectomy.

If a patient presents with a primary lesion and metastatic disease, they are typically given systemic therapy first because the efficacy of systemic therapy has greatly improved, explains Vaishampayan. After, cytoreductive nephrectomy is considered. A new SWOG trial will assess the efficacy of treating patients with contemporary immunotherapy upfront, then randomizing patients to receive cytoreductive nephrectomy or continue on systemic therapy, says Vaishampayan.

Systemic therapy upfront should be considered for patients with synchronous metastatic disease. After, cytoreductive nephrectomy should be considered for these patients. The decision regarding the nephrectomy would depend on the patient’s response to treatment, how they are feeling overall, and what kind of performance status they are maintaining, concludes Vaishampayan.