Elsevier

Urology

Volume 121, November 2018, Pages 1-2
Urology

Journal Watch
Has the Age of Cytoreductive Nephrectomy Come to an End?: Commentary on: Sunitinib Alone or After Nephrectomy in Metastatic Renal-Cell Carcinoma

https://doi.org/10.1016/j.urology.2018.07.007Get rights and content

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SUMMARY

The CARMENA (Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques) trial1 was a prospective, multicentre, open-label, phase-3 trial that randomly assigned patients with Memorial Sloan Kettering Cancer Center (MSKCC) intermediate- or poor-risk metastatic renal cell carcinoma (mRCC) to undergo cytoreductive nephrectomy (CNx) followed by sunitinib or to sunitinib alone without nephrectomy. The study was designed to test the noninferiority of sunitinib alone with respect to the primary

COMMENT

The authors of this paper should be congratulated for conducting this challenging trial to address the role of CNx in the era of targeted therapy. The value of CNx was established in a previous era of relatively ineffective cytokine therapy2, 3 and has persisted with the advent of VEGFR and mTOR pathway inhibitors without being tested in a prospective, randomized trial. Several large-scale retrospective studies and a meta-analysis found CNx to have favorable effects on survival, 4, 5, 6 and CNx

Cited by (3)

  • Outcomes following cytoreductive nephrectomy without immediate postoperative systemic therapy for patients with synchronous metastatic renal cell carcinoma

    2022, Urologic Oncology: Seminars and Original Investigations
    Citation Excerpt :

    In particular, the limited response rate with cytokine therapy alone allowed CN to carve out a role in the management of metastatic renal cell carcinoma (mRCC) [9,10]. Following the introduction of targeted therapies in 2006, the role of CN has come into question given the improved efficacy of systemic therapy [11]. More recently, the CARMENA trial reported that sunitinib alone (median overall survival [OS] 18.4 months) was non-inferior to CN followed by sunitinib (median OS 13.9 months) in patients with mRCC requiring systemic therapy [12].

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