Is cytoreductive nephrectomy relevant in the immunotherapy era?

Area of Science:

• Oncology
• Immunotherapy
• Surgical Oncology

Background:

• Immune checkpoint inhibitors (ICI) have transformed metastatic renal cell carcinoma (mRCC) treatment.
• The role of cytoreductive nephrectomy (CN) in the context of ICI therapy for mRCC is not well-established.

Purpose of the Study:

• To review the current role and optimal timing of CN for advanced RCC in the era of immunotherapy.
• To discuss patient selection criteria for CN in advanced RCC patients receiving ICI.

Main Methods:

• Review of contemporary evidence on CN in mRCC.
• Analysis of studies from the targeted therapy era and case reports in the ICI era.
• Discussion of ongoing clinical trials investigating CN in the immunotherapy setting.

Main Results:

• Evidence for CN combined with systemic therapy in mRCC is mainly from the targeted therapy era.
• The oncologic benefit of CN with ICI is largely undefined, supported mainly by case reports.
• Patient selection for CN is critical, and optimal candidacy in the ICI era requires further evidence.

Conclusions:

• The role and timing of CN in advanced RCC with ICI require further elucidation.
• Careful patient selection is paramount for treatment planning in the current immunotherapy era.
• Ongoing trials are essential to define the precise role, technical feasibility, and optimal timing of CN in mRCC patients treated with ICI.