Dr. Clark on the Role of Cytoreductive Nephrectomy in RCC

Peter Clark, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses the role of cytoreductive nephrectomy in the treatment of patients with renal cell carcinoma (RCC).

The use of cytoreductive nephrectomy has long been debated—increasingly so since the advent of TKIs. The CARMENA trial tested the value of cytoreductive nephrectomy plus adjuvant sunitinib (Sutent) compared with sunitinib alone in patients with metastatic RCC. The trial showed that there was no difference between a nephrectomy and adjuvant sunitinib versus single-agent sunitinib.

The TKI showed median overall survival (OS) rates of 23.4 months and 19.0 months in intermediate-risk patients with sunitinib monotherapy and nephrectomy followed by sunitinib, respectively (HR, 0.92; 95% CI, 0.68-1.24). Median OS rates in poor-risk patients were 13.3 months and 10.2 months, respectively (HR, 0.85; 95% CI, 0.62-1.17). Now, physicians are navigating surgery’s application by way of careful patient selection. The procedure should not be used freely and should not be used in the highest-risk patients. It should also be avoided in patients who have unresectable disease, concludes Clark.