Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 1/2012

01-02-2012 | Kidney Diseases (G Ciancio, Section Editor)

Role of Cytoreductive Nephrectomy in the Era of Targeted Therapy for Renal Cell Carcinoma

Authors: Paul L. Crispen, Michael L. Blute

Published in: Current Urology Reports | Issue 1/2012

Login to get access

Abstract

With the advent of targeted therapy for the treatment of metastatic renal cancer, the routine use of cytoreductive nephrectomy has been questioned. However, available data suggest that cytoreductive nephrectomy remains an integral part of treatment in properly selected patients. This review details the rationale for the continued use of cytoreductive nephrectomy in acceptable surgical candidates in the era of targeted therapy.
Literature
1.
Jeldres C, Baillargeon-Gagne S, Liberman D, et al. A population-based analysis of the rate of cytoreductive nephrectomy for metastatic renal cell carcinoma in the United States. Urology. 2009;74:837–41.PubMedCrossRef
2.
Zini L, Capitanio U, Perrotte P, et al. Population-based assessment of survival after cytoreductive nephrectomy versus no surgery in patients with metastatic renal cell carcinoma. Urology. 2009;73:342–6.PubMedCrossRef
3.
Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345:1655–9.PubMedCrossRef
4.
Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358:966–70.PubMedCrossRef
5.
Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004;171:1071–6.PubMedCrossRef
6.
Lara Jr PN, Tangen CM, Conlon SJ, Flanigan RC, Crawford ED. Predictors of survival of advanced renal cell carcinoma: long-term results from Southwest Oncology Group Trial S8949. J Urol. 2009;181:512–6.PubMedCrossRef
7.
Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356:115–24.PubMedCrossRef
8.
Rini BI, Halabi S, Rosenberg JE, et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal cell carcinoma: final results of CALGB 90206. J Clin Oncol. 2010;28:2137–43.PubMedCrossRef
9.
Escudier B, Bellmunt J, Negrier S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol. 2010;28:2144–50.PubMedCrossRef
10.
Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356:125–34.PubMedCrossRef
11.
Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol. 2010;28:1061–8.PubMedCrossRef
12.
Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356:2271–81.PubMedCrossRef
13.
Culp SH, Tannir NM, Abel EJ, et al. Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy? Cancer. 2010;116:3378–88.PubMedCrossRef
14.
•• Richey SL, Culp SH, Jonasch E, et al. Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. Ann Oncol. 2011;22:1048–53. This article provides data on patients treated with targeted therapy alone and prognostic factors in this patient population.
15.
Motzer RJ, Bukowski RM, Figlin RA, et al. Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer. 2008;113:1552–8.PubMedCrossRef
16.
Karakiewicz PI, Sun M, Bellmunt J, Sneller V, Escudier B. Prediction of progression-free survival rates after bevacizumab plus interferon versus interferon alone in patients with metastatic renal cell carcinoma: comparison of a nomogram to the Motzer criteria. Eur Urol. 2011;60:48–56.PubMedCrossRef
17.
•• Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27:5794–9. The data provided in this article can be extremely useful for risk stratification of patients receiving targeted therapy for metastatic renal cancer. PubMedCrossRef
18.
Choueiri TK, Garcia JA, Elson P, et al. Clinical factors associated with outcome in patients with metastatic clear-cell renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. Cancer. 2007;110:543–50.PubMedCrossRef
19.
Sun M, Shariat SF, Cheng C, et al. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. Eur Urol. 2011; In press.
20.
You D, Jeong IG, Ahn JH, et al. The value of cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy. J Urol. 2011;185:54–9.PubMedCrossRef
21.
•• Choueiri TK, Xie W, Kollmannsberger C, et al. The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol. 2011;185:60–6. This article provides initial data on the potential benefit of cytoreductive nephrectomy in patients receiving targeted therapy. PubMedCrossRef
22.
Russo P. Multi-modal treatment for metastatic renal cancer: the role of surgery. World J Urol. 2010;28:295–301.PubMedCrossRef
23.
Karam JA, Wood CG. The role of surgery in advanced renal cell carcinoma: cytoreductive nephrectomy and metastasectomy. Hematol Oncol Clin North Am. 2011;25:753–64.PubMedCrossRef
24.
•• Alt AL, Boorjian SA, Lohse CM, Costello BA, Leibovich BC, Blute ML. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer 2011;117:2873–82. This article provides detailed data and discussion on the benefit of complete metastasectomy in metastatic renal cancer. PubMedCrossRef
25.
Di Lorenzo G, Porta C, Bellmunt J, et al. Toxicities of targeted therapy and their management in kidney cancer. Eur Urol. 2011;59:526–40.PubMedCrossRef
26.
Barbastefano J, Garcia JA, Elson P, et al. Association of percentage of tumour burden removed with debulking nephrectomy and progression-free survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. BJU Int. 2010;106:1266–9.PubMedCrossRef
27.
Karam JA, Rini BI, Varella L, et al. Metastasectomy after targeted therapy in patients with advanced renal cell carcinoma. J Urol. 2011;185:439–44.PubMedCrossRef
28.
Bex A, Jonasch E, Kirkali Z, et al. Integrating surgery with targeted therapies for renal cell carcinoma: current evidence and ongoing trials. Eur Urol. 2010;58:819–28.PubMedCrossRef
29.
Kutikov A, Uzzo RG, Caraway A, et al. Use of systemic therapy and factors affecting survival for patients undergoing cytoreductive nephrectomy. BJU Int. 2009;106:218–23.PubMedCrossRef
30.
•• Chapin BF, Delacroix SE, Jr., Culp SH, et al. Safety of presurgical targeted therapy in the setting of metastatic renal cell carcinoma. Eur Urol. 2011;In press. This article is an extremely insightful description of postoperative complications in patients receiving presurgical therapy and provides initial outcome data.
31.
Powles T, Kayani I, Blank C, et al. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol. 2011;22:1041–7.PubMedCrossRef
32.
Rathmell WK, Pruthi R, Wallen E. Neoadjuvant treatment of renal cell carcinoma. Urol Oncol. 2010;28:69–73.PubMedCrossRef
33.
Thomas AA, Rini BI, Lane BR, et al. Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma. J Urol. 2009;181:518–23.PubMedCrossRef
34.
Abel EJ, Culp SH, Tannir NM, et al. Primary tumor response to targeted agents in patients with metastatic renal cell carcinoma. Eur Urol. 2011;59:10–5.PubMedCrossRef
35.
Wood CG, Margulis V. Neoadjuvant (presurgical) therapy for renal cell carcinoma: a new treatment paradigm for locally advanced and metastatic disease. Cancer. 2009;115:2355–60.PubMedCrossRef
36.
Abel EJ, Culp SH, Tannir NM, Tamboli P, Matin SF, Wood CG. Early primary tumor size reduction is an independent predictor of improved overall survival in metastatic renal cell carcinoma patients treated with sunitinib. Eur Urol. 2011; In press.
37.
Karnes RJ, Blute ML. Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus. Nat Clin Pract Urol. 2008;5:329–39.PubMedCrossRef
38.
Cost NG, Delacroix Jr SE, Sleeper JP, et al. The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol. 2011;59:912–8.PubMedCrossRef
39.
Patard JJ, Pignot G, Escudier B, et al. ICUD-EAU International consultation on kidney cancer 2010: treatment of metastatic disease. Eur Urol. 2011; In press.
40.
Abdollah F, Sun M, Thuret R, et al. Mortality and morbidity after cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based study. Ann Surg Oncol. 2011; In press.
41.
Polcari AJ, Gorbonos A, Milner JE, Flanigan RC. The role of cytoreductive nephrectomy in the era of molecular targeted therapy. Int J Urol. 2009;16:227–33.PubMedCrossRef
42.
Spiess PE, Fishman MN. Cytoreductive nephrectomy vs medical therapy as initial treatment: a rational approach to the sequence question in metastatic renal cell carcinoma. Cancer Control. 2010;17:269–78.PubMed
43.
Chiong E, Wood CG, Margulis V. Role of cytoreductive nephrectomy in renal cell carcinoma. Future Oncol. 2009;5:859–69.PubMedCrossRef
44.
Abel EJ, Culp SH, Matin SF, et al. Percutaneous biopsy of primary tumor in metastatic renal cell carcinoma to predict high risk pathological features: comparison with nephrectomy assessment. J Urol. 2010;184:1877–81.PubMedCrossRef
Metadata
Title
Role of Cytoreductive Nephrectomy in the Era of Targeted Therapy for Renal Cell Carcinoma
Authors
Paul L. Crispen
Michael L. Blute
Publication date
01-02-2012
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 1/2012
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-011-0225-x

Other articles of this Issue 1/2012

Current Urology Reports 1/2012 Go to the issue

New Techniques: Imaging (A Atala, Section Editor)

Update on Thermal Ablation of Renal Cell Carcinoma: Oncologic Control, Technique Comparison, Renal Function Preservation, and New Modalities

New Techniques: Imaging (A Atala, Section editor

Dual-energy Computed Tomography Applications in Uroradiology

Kidney Diseases (G Ciancio, Section Editor)

Update on Surgical Management of Renal Cell Carcinoma with Venous Extension

Kidney Diseases (G Ciancio, Section Editor)

Stem Cells as a Therapeutic Approach to Chronic Kidney Diseases

New Techniques: Imaging (A Atala, Section Editor)

Advanced Renal Mass Imaging: Diffusion and Perfusion MRI

Kidney Diseases (G Ciancio, Section Editor)

Current Status of Robot-Assisted Partial Nephrectomy