Ulka Vaishampayan, MD
Cytoreductive nephrectomy should be considered after systemic therapy, if at all, in the majority of patients with metastatic renal cell carcinoma (mRCC), according to Ulka Vaishampayan, MD, a professor of oncology at Wayne State University.
“If the patient presents with oligometastatic disease that is resectable, we may consider nephrectomy and resection of the metastatic sites. However, the majority of patients have unresectable metastatic disease,” said Vaishampayan. “These patients should start on systemic therapy. Depending on their response and [the amount of] residual disease, [we will] decide whether to [proceed with nephrectomy] or switch to another systemic therapy.”
This rationale is based on findings from the phase III CARMENA trial, in which patients with intermediate- and poor-risk disease had noninferior overall survival (OS) with cytoreductive nephrectomy followed by sunitinib (Sutent) versus sunitinib alone (HR, 0.89; 95% CI, 0.71-1.10).1
With longer-term follow-up at 61.5 months, the median OS in the intent-to-treat population was 15.6 months with cytoreductive nephrectomy/sunitinib versus 19.8 months with sunitinib alone (HR, 0.97; 95% CI, 0.79-1.19).2
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