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The role of cytoreductive nephrectomy for renal cell carcinoma in the era of targeted therapy

Nature Clinical Practice Oncology volume 5, pages 698–699 (2008)Cite this article

Cytoreductive nephrectomy (CN) is well-established as an integral part of the treatment of patients with metastatic renal cell carcinoma (RCC). The procedure was adopted on the basis of the results of two prospective, randomized trials that compared CN followed by interferon with interferon monotherapy.1,2 A combined analysis of these trials showed a survival advantage for cytoreduction followed by interferon with a median survival of 13.6 months compared with 7.8 months for interferon monotherapy (P = 0.002).3 Consequently, the standard management of patients with metastatic RCC became CN followed by immunotherapy, usually interferon or interleukin 2.

These randomized trials, however, were unable to provide insight into the mechanisms behind the survival benefit conferred by debulking nephrectomy, especially since survival was not dependent on the response to interferon. Several biologic hypotheses support the theory that immunosuppressive activity is reversed after nephrectomy, owing to resection of the primary tumor.4 An angiogenic theory is also plausible: increased serum levels of vascular endothelial growth factor (VEGF) have been found in patients with RCC, and a correlation with tumor stage has been established.5 A reduction in the levels of VEGF, achieved by removal of a bulky primary tumor, could prevent rapid progression.

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References

  1. Flanigan RC et al. (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345: 1655–1659

    Article  CAS  Google Scholar 

  2. Mickisch GH et al. (2001) Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 358: 966–970

    Article  CAS  Google Scholar 

  3. Flanigan RC et al. (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171: 1071–1076

    Article  Google Scholar 

  4. Tatsumi T et al. (2003) Disease stage variation in CD4+ and CD8+ T-cell reactivity to the receptor tyrosine kinase EphA2 in patients with renal cell carcinoma. Cancer Res 63: 4481–4489

    CAS  PubMed  Google Scholar 

  5. Jacobsen J et al. (2000) Vascular endothelial growth factor as prognostic factor in renal cell carcinoma. J Urol 163: 343–347

    Article  CAS  Google Scholar 

  6. Escudier B et al. (2007) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356: 125–134

    Article  CAS  Google Scholar 

  7. Motzer RJ et al. (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356: 115–124

    Article  CAS  Google Scholar 

  8. Hudes G et al. (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356: 2271–2281

    Article  CAS  Google Scholar 

  9. Escudier B et al. (2007) Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet 370: 2103–2111

    Article  Google Scholar 

  10. Rini BI et al. (2008) CALGB 90206: A phase III trial of bevacizumab plus interferon-alpha versus interferon-alpha monotherapy in metastatic renal cell carcinoma [Abstract #350]. 2008 ASCO Genitourinary Cancers Symposium: 2008 February 14–16; San Francisco.

    Google Scholar 

  11. Rathmell KA et al. (2008) Neoadjuvant therapy with sorafenib for locally advanced renal cell carcinoma (RCC) [Abstract #370]. 2008 ASCO Genitourinary Cancers Symposium: 2008 February 14–16; San Francisco

    Google Scholar 

  12. Margulis V and Wood CG (2008) Cytoreductive nephrectomy in the era of targeted molecular agents: is it time to consider presurgical systemic therapy? Eur Urol 54: 489–492

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. S Chowdhury is a Consultant in the Department of Medical Oncology at Guy's Hospital, London, UK.,

    Simon Chowdhury

  2. PG Harper is a Consultant Medical Oncologist at Guy's and St Thomas's Hospital National Health Service Trust, London, UK.,

    Peter G Harper

  3. TK Choueiri is a Faculty Member at the Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,

    Toni K Choueiri

Authors
  1. Simon Chowdhury
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  2. Peter G Harper
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  3. Toni K Choueiri
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Correspondence to Simon Chowdhury.

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Chowdhury, S., Harper, P. & Choueiri, T. The role of cytoreductive nephrectomy for renal cell carcinoma in the era of targeted therapy. Nat Rev Clin Oncol 5, 698–699 (2008). https://doi.org/10.1038/ncponc1256

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