Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

KIDNEY CANCER

Cytoreductive nephrectomy in metastatic renal cancer — less is more

CARMENA, a trial comparing the efficacy of sunitinib alone to that of nephrectomy followed by sunitinib in patients with primary metastatic renal cell carcinoma who require targeted therapy has demonstrated the non-inferiority of systemic therapy alone. The data provided by this and other studies argue for a lesser role of surgery in the management of these patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Ljungberg, B. et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur. Urol. 67, 913–924 (2015).

    Article  Google Scholar 

  2. Mejean, A. et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1803675 (2018).

    Article  Google Scholar 

  3. Mejean, A. et al. CARMENA: cytoreductive nephrectomy followed by sunitinib versus sunitinib alone in metastatic renal cell carcinoma—results of a phase III noninferiority trial [abstract]. J. Clin. Oncol. 36 (suppl.), LBA3 (2018).

    Article  Google Scholar 

  4. Heng, D. Y. et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur. Urol. 66, 704–710 (2014).

    Article  Google Scholar 

  5. Powles, T. et al. The outcome of patients treated with sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer. Eur. Urol. 60, 448–454 (2011).

    Article  CAS  Google Scholar 

  6. Powles, T. et al. Safety and efficacy of pazopanib therapy prior to planned nephrectomy in metastatic clear cell renal cancer. JAMA Oncol. 2, 1303–1309 (2016).

    Article  Google Scholar 

  7. Bex, A. et al. Immediate versus deferred cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mRCC) receiving sunitinib (EORTC 30073 SURTIME). Ann. Oncol. 28 (suppl. 5), md440.030 (2017).

    Google Scholar 

  8. Turajlic, S. et al. Tracking cancer evolution reveals constrained routes to metastases: TRACERx Renal. Cell 173, 581–594 (2018).

    Article  CAS  Google Scholar 

  9. Motzer, R. J. et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N. Engl. J. Med. 378, 1277–1290 (2018).

    Article  CAS  Google Scholar 

  10. McDermott, D. F. et al. Clinical activity and molecular correlates of response to atezolizumab alone or in combination with bevacizumab versus sunitinib in renal cell carcinoma. Nature Med. 24, 749–757 (2018).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Axel Bex.

Ethics declarations

Competing interests

A.B. has served on the advisory boards of Bristol-Myers Squibb (BMS), Genentech, Ipsen, Novartis, Pfizer, and Roche. All remunerations were made to an institutional account. He was the principle investigator of the European Organisation for Research and Treatment of Cancer (EORTC) SURTIME trial that was in part funded by an educational grant from Pfizer to the EORTC. J.H. has served on the advisory boards of BMS, Genentech, Merck, Novartis, Pfizer, and Roche. All remunerations were made to an institutional account.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bex, A., Haanen, J. Cytoreductive nephrectomy in metastatic renal cancer — less is more. Nat Rev Clin Oncol 15, 595–596 (2018). https://doi.org/10.1038/s41571-018-0065-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41571-018-0065-4

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing