Cytoreductive nephrectomy: questions remain after CARMENA

Cytoreductive nephrectomy, a standard approach for de novo metastatic renal cell carcinoma in the era of cytokine therapy, has been upheld during the age of targeted therapy on the basis of retrospective data. Now, the first level I prospective data from the CARMENA and SURTIME trials challenge this standard.

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Fig. 1: Proposed ‘CARMENA-like’ clinical trial designs.


  1. 1.

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

  2. 2.

    Hanna, N. et al. Survival analyses of patients with metastatic renal cancer treated with targeted therapy with or without cytoreductive nephrectomy: a national cancer data base study. J. Clin. Oncol. 34, 3267–3275 (2016).

  3. 3.

    Bex, A. et al. Immediate versus deferred cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mRCC) receiving sunitinib. Ann. Oncol. 28, v605–v649 (2017).

  4. 4.

    Méjean, A. et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N. Engl. J. Med. (2018).

  5. 5.

    Motzer, R. J. et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J. Clin. Oncol. 20, 289–296 (2002).

  6. 6.

    Heng, D. Y. 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. 27, 5794–5799 (2009).

  7. 7.

    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).

  8. 8.

    Culp, S. H. et al. Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy? Cancer 116, 3378–3388 (2010).

  9. 9.

    Bhindi, B. et al. Comparative survival following initial cytoreductive nephrectomy versus initial targeted therapy for metastatic renal cell carcinoma. J. Urol. (2018).

  10. 10.

    Barata, P. C. & Rini, B. I. Treatment of renal cell carcinoma: current status and future directions. CA Cancer J. Clin. 67, 507–524 (2017).

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Correspondence to Sumanta K. Pal.

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Bhanvadia, S., Pal, S.K. Cytoreductive nephrectomy: questions remain after CARMENA. Nat Rev Urol 15, 530–532 (2018).

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