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.

KIDNEY CANCER

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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

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

References

  1. 1.

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

    Article  PubMed  Google Scholar 

  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).

    Article  PubMed  PubMed Central  Google Scholar 

  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).

    Article  Google Scholar 

  4. 4.

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

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  CAS  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

  9. 9.

    Bhindi, B. et al. Comparative survival following initial cytoreductive nephrectomy versus initial targeted therapy for metastatic renal cell carcinoma. J. Urol. https://doi.org/10.1016/j.juro.2018.03.077 (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).

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sumanta K. Pal.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bhanvadia, S., Pal, S.K. Cytoreductive nephrectomy: questions remain after CARMENA. Nat Rev Urol 15, 530–532 (2018). https://doi.org/10.1038/s41585-018-0064-3

Download citation

Further reading

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