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Exploring the Role of Cytoreductive Nephrectomy in RCC

Brandon Scalea
Published: Thursday, Mar 21, 2019

Brian M. Shuch, MD

Brian M. Shuch, MD

Although recent studies have failed to establish the relevance of cytoreductive nephrectomy in the treatment of patients with advanced renal cell carcinoma (RCC), a true multidisciplinary approach may be able to help answer this question, said Brian M. Shuch, MD.

For example, the phase III CARMENA trial evaluated the benefit of sunitinib (Sutent) monotherapy versus nephrectomy followed by sunitinib. Data showed that sunitinib alone was noninferior to nephrectomy and sunitinib.1 Specifically, the median overall survival (OS) for those treated with VEGF TKI therapy alone was 18.4 months compared with 13.9 months for patients who underwent nephrectomy. The same held true for those classified as having intermediate-risk (23.4 months vs 19.0 months) or poor-risk (13.3 months vs 10.2 months) disease.

In another phase III trial, the SURTIME study, patients were randomized to receive immediate cytoreductive nephrectomy followed by sunitinib or 3 cycles of sunitinib followed by nephrectomy in the absence of progression followed by sunitinib. Results showed no statistically significant difference in progression-free survival (PFS) rate at 28 weeks, although an OS analysis indicated that deferred nephrectomy could have an advantage over immediate surgery.2

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